Oral
Answers to
Questions

Health and Social Care

The Secretary of State was asked—

Urgent and Emergency Care: Growing Towns

Mark Pawsey: What assessment his Department has made of the adequacy of urgent and emergency care provision in towns with significant population growth.

Will Quince: Our recovery plan for urgent and emergency care provides £1 billion of additional funding for NHS capacity, alongside £250 million for capital improvement schemes up and down the country. Local integrated care boards are now responsible for working with their partners to decide how best to use that funding to improve services to meet the health needs of their changing populations, and all integrated care boards will shortly set out their plans for the next five years through a joint forward plan process.

Mark Pawsey: Rugby is the largest urban area within Coventry and Warwickshire that does not have its own A&E provision. In the wider region, Kettering, Shrewsbury, Redditch and Burton upon Trent all have similar or smaller populations, each with their own A&E services. Rugby is growing fast, with 12,500 homes being delivered between 2016 and 2031, when the population will exceed 135,000. Will the Minister say at what population level it will be appropriate for local health commissioners to upgrade the A&E provision at the Hospital of St Cross in Rugby?

Will Quince: As my hon. Friend knows, the provision of services, including accident and emergency, are a matter for local NHS commissioners and providers. I know that he regularly meets local NHS leaders about this matter and will continue to do so. I am very happy to meet him and, of course, visit. Funding for Coventry and Warwickshire Integrated Care Board has increased to over £1.6 billion this year. My hon. Friend is a huge champion for his constituents; I would be happy to meet and visit.

John Cryer: The population of my constituency is due to grow rapidly over the next 10 years and beyond. On that basis, can the Minister give a completion date for the new Whipps Cross Hospital, which was announced last week?

Will Quince: By 2030, Mr Speaker.

Lindsay Hoyle: And obviously we want 24-hour provision in Chorley, which has the fastest-growing population, but let us move on.

Complex Mental Health Needs: Young People

Sarah Green: What assessment he has made of the adequacy of the treatment and care available for young people with complex mental health needs.

Steve Barclay: We have recruited an extra 4,500 NHS children’s mental health specialists, which is a 40% increase on 2019. That is part of our additional £2.3 billion of investment into mental health services, compared to four years ago.

Sarah Green: Earlier this year, I was contacted by a mother who told me how her daughter, who has been both autistic and anorexic, has been receiving treatment since she was 13. Sadly, her condition has significantly deteriorated in that time, and it is her firm belief that closer integration of the different services she was accessing would have resulted in much better outcomes for her daughter. Will the Secretary of State consider a review of mental health services for children and young people, to look at how to better integrate services and ensure continuity of care?

Steve Barclay: I am sure the whole House is sorry to hear that her constituent’s condition has deteriorated. The hon. Lady raises a very important point about integration, which is exactly the right approach. The 2022 reforms were about integrating health and social care and empowering commissioners to take a more integrated place-based approach. I am sure her local commissioners will take note of the valid point that she raises.

Lindsay Hoyle: I call the shadow Minister for mental health.

Rosena Allin-Khan: A 14-year old climbing out of hospital windows; a child absconding to a local railway station; a teenager with complex needs brought to A&E, requiring four police officers to spend an entire shift watching them, only for them to abscond the next day. There is a pattern here. At almost every step of the way, children needing mental health services face a perfect storm of delay and treatment in inappropriate settings, fuelled by an under-resourced service with over-stretched staff. In light of the Met’s announcement that they will stop attending emergency mental health calls, is it not time for the Government to get their act together, or simply do the right thing and step aside?

Steve Barclay: One can see the way the Government are responding constructively to these issues by looking at the pilots we have been rolling out in Humberside, where police are released within one hour in 80% of section 136 detentions. We intend to roll out that pilot nationally.
The hon. Lady is right on the first part of her challenge, as demand for mental health services is increasing. In fact, there was a 41% increase in new referrals to mental health services in 2021 compared to the previous year. Where she is wrong is on the resourcing. She missed my previous answer that set out how we are committing an extra £2.3 billion of investment into mental health services, compared to four years ago.

Notices of Decision for Care  Homes: Change of Ownership

Taiwo Owatemi: Whether he is taking steps to ensure that notices of decision for care homes do not lapse upon a change of ownership unless standards improve.

Helen Whately: When a care home is taken over, the Care Quality Commission assesses and re-rates it under its new ownership. Previous notices of decision cannot legally be passed to a new provider, but they do inform the CQC’s approach to an assessment and how soon it takes place. During the time between the takeover and the CQC’s carrying out a new assessment, the legacy rating is shown on the CQC website.

Taiwo Owatemi: My constituents Brenda, Gary and Trina lost their parents after they were placed in Melbourne House care home, which the CQC later deemed to be “inadequate”. However, because the notice of decision lapsed on its transfer to the original owner’s family, the home, now known as Earlsdon Lodge, is able to operate as if nothing had happened. Will the Minister meet my constituents and me to explain exactly why that was allowed to happen, and what is being done to prevent it from happening to other families?

Helen Whately: I shall be happy to meet the hon. Member to look into that case, because I feel strongly about the importance of ensuring that everyone has access to good, if not outstanding, care in care homes.

Sun Protection Products: Affordability

Richard Thomson: If he will make an assessment with Cabinet colleagues of the potential impact of increasing the affordability of sun protection products on levels of skin cancer.

Neil O'Brien: Last month was melanoma month and skin cancer month, and people are increasingly aware of the risks of excessive sun exposure without protection. Through the energy price guarantee and our direct support for vulnerable households, we have provided cost of living help worth, on average, £3,300 per household.

Richard Thomson: Since the early 1990s cases of skin cancer have doubled, with nearly 16,000 new cases diagnosed each year leading to 2,300 avoidable deaths annually. If some products were more affordable, more of our constituents might be able to use them and bring those numbers down. Will the ministerial team make representations to their Treasury colleagues about the Sun Protection Products (Value Added Tax) Bill, a private Member’s Bill promoted by my hon. Friend the Member for East Dunbartonshire (Amy Callaghan) which would remove VAT from some sun protection products, so that we can start to make an impact on those appalling figures?

Neil O'Brien: As the hon. Gentleman knows, tax matters are for the Treasury, but we are absolutely committed to providing cost of living support. By the end of June the Government will have covered nearly  half a typical household’s energy bill since October, so we are providing one of the most generous packages in Europe.

Lindsay Hoyle: I call the Scottish National party spokesperson.

Martyn Day: The last time I asked Ministers whether they would support that Bill I was told that the issue of VAT and skin cancer was a matter for the Treasury, and we have just heard a similar answer. Surely this is a matter for joined-up government. What are Ministers doing—instead of imposing more pressure and costs on the NHS—to persuade their Treasury colleagues to consider more cost-effective cost preventive measures such as making skin protection products more affordable?

Neil O'Brien: The hon. Gentleman is campaigning for a reduction in the VAT on suncream, but let me put this into perspective. As I have said, our cost of living support is worth, on average, £3,300 per household. That is help on a huge scale. On cancer we are taking more action across the piece, and more people are being given life-saving checks, referrals and treatment than before.

Cancer Waiting Times and Outcomes

Kate Hollern: What steps he is taking to improve cancer waiting times and outcomes.

Clive Betts: What steps he is taking to improve cancer waiting times and outcomes.

Holly Mumby-Croft: What progress his Department has made on improving cancer survival rates.

Mary Glindon: What steps he is taking to improve cancer waiting times and outcomes.

Steve Barclay: We are diagnosing and treating patients faster. In March, nearly three in four people were diagnosed or given the all-clear within two weeks—ahead of the 28-day target—and nine in 10 patients start treatment within a month.

Kate Hollern: In May last year I wrote to the then Health Secretary and the Prime Minister about the case of a young man in my constituency, Elliott Simpson, who was misdiagnosed with a water wart in a telephone consultation with a GP. When Elliott was finally able to see someone face-to-face, he found that he had late-stage skin cancer. He passed away on 28 April, aged just 27.
Between January and March this year, both the two-week wait target and the 62-day target were missed at East Lancashire Hospitals NHS Trust. Does the Secretary of State accept that delays are costing lives?

Steve Barclay: The whole House will be hugely saddened to learn of the passing of Elliott, especially at such a tender age.[Official Report, 20 July 2023, Vol. 736, c. 16MC.]
The hon. Lady is right to highlight the importance of speedy diagnosis, and I was pleased that we met the faster diagnosis standard in February for the first time and again in March, with three in four patients receiving their diagnosis within two weeks and nine in 10 starting treatment within a month. She is also right to point out that there is still variation between trusts, and we are focusing on that in particular, but it is good that nationally we are hitting the faster diagnosis standard.

Clive Betts: When I was diagnosed with multiple myeloma six years ago, my GP gave me two pieces of advice: keep positive and keep active. The other day, I visited the wellbeing centre in my constituency, which is run by Sheffield Hallam University, the Sheffield Teaching Hospitals NHS Foundation Trust and Yorkshire Cancer Research. It is putting on a programme called Active Together to which people who are diagnosed with cancer can be referred by their consultant and have a bespoke programme of treatment involving physical activity, nutrition and psychological support to prepare them for surgery, and a programme after surgery to help them recover. Would the Secretary of State like to come to my constituency to visit this novel and innovative programme to see how it could be rolled out across the country and treat more cancers well in this way?

Steve Barclay: The hon. Gentleman raises an interesting and important point. How we better equip patients pre-surgery and post-surgery, how we look at their wellbeing—the keep positive bit and the social prescribing—and how we think about being active are all are hugely important. I would be keen to learn more about the programme that he highlights and for either me or one of the ministerial team to follow up on his offer.

Holly Mumby-Croft: In March, the all-party parliamentary group on brain tumours published its report into research funding, which found that only about £15 million of the £40 million pledged has made its way into the hands of the researchers. Can the Secretary of State set out what we can do to fix these challenges in the funding system so that we can get that money into the hands of the researchers and improve those outcomes?

Steve Barclay: I welcome the fact that my hon. Friend has raised this point, because the £40 million of funding is available. That money is there, ready to allocate to quality bids. All the bids that have met the National Institute for Health and Care Research standard have been funded, but she is right to say that there is more money available and we stand ready to work with researchers to get that money allocated as soon as those quality bids come in.

Mary Glindon: Analysis by Cancer Research UK projects that, by 2040, cancer cases will rise to over half a million new cases a year. Will the Secretary of State confirm when the NHS long-term workforce plan will be published, that it will set out transparent projections for workforce need for the next five, 10 and 15 years, and that it will be fully funded to ensure that there are enough staff to deliver timely diagnosis and treatment for cancer patients?

Steve Barclay: The hon. Lady is correct to say that demand for cancer services is increasing. We have seen demand up a fifth recently. That is why, alongside the long-term workforce plan, to which we are committed—the Chancellor set out that commitment in the autumn statement—we are also putting over £5 billion of investment into diagnostic centres, surgical hubs and equipment in order to better provide, alongside the workforce, the skills and equipment we need to treat cancer.

John Baron: What assurance can the Secretary of State give that both the letter and the spirit of section 5 of the Health and Care Act 2022 will be embraced to encourage the NHS to improve early diagnosis and therefore cancer survival rates by focusing on outcome measures such as the one-year survival rate, so that we can start catching up with international averages when it comes to survival?

Steve Barclay: I pay tribute to my hon. Friend, who has long championed this issue. Indeed, he secured an amendment to the Health and Care Act as part of that campaign. We will be fulfilling our obligation by including an objective on cancer outcomes when we publish the next mandate to NHS England, and I hope he will see that as a welcome step.

Maggie Throup: To improve cancer waiting times and outcomes, and learning from the success of the covid vaccine roll-out where hard-to-reach cohorts were vaccinated in everyday settings such as shopping centres and football stadiums, will my right hon. Friend look at locating more community diagnostic centres away from formal clinical settings in hospitals and taking them out into the community?

Steve Barclay: This is an innovative and exciting development, thinking about how we offer services in different ways and bring those services to patients much more locally. The community diagnostic centres are a huge step forward in that, but we should also be looking at our engagement with employers, at how we use more tests at home and at the successes we have had, for example, with some of the screening programmes in order to offer more services closer to patients.

Chris Bryant: The figures on diagnosing people with cancer are certainly improving, but what is getting worse, and has got significantly worse in the last three months, is the starting of treatment for people who definitely have cancer. The figures are now the worst on record, with 19,000 people waiting for treatment, and all the evidence suggests that waiting another week adds 10% to the likelihood of death. Can I please urge the Minister not always to give the rosy, good statistics but to face up to the fact that there are real dangers in the statistics, too?

Steve Barclay: I know the hon. Gentleman takes a very close interest in this, and we can all see that there is a shared desire to meet the increasing demand. He recognises the progress on diagnostics. Nine in 10 patients are starting treatment within a month, and the all cancer survival index for England is steadily increasing, but I agree that there is much more still to do, which is why we are investing in diagnostic centres, surgical hubs and the long-term workforce plan. I am very happy to continue working with him and other colleagues as we meet this ongoing challenge.

Virginia Crosbie: Does the Minister agree that one of the ways we can improve cancer care and outcomes is by supporting brilliant charities such as Chemocare Bags? Emma Hart and her team do an outstanding job of putting together bags, which include fluffy socks, puzzle books, colouring books, mints and lip salve, for those starting chemotherapy at Ysbyty Gwynedd in Bangor.

Steve Barclay: I am very happy to join my hon. Friend in paying tribute to all those who support Chemocare Bags for the fantastic work they do. That sort of support makes a real difference to patients, and the NHS benefits hugely from the work of volunteers, including those at Chemocare Bags.

Lindsay Hoyle: I call the shadow Minister.

Andrew Gwynne: As my hon. Friend the Member for Rhondda (Sir Chris Bryant) pointed out, the brutal truth is that the Tories have consistently missed England’s cancer treatment target since 2013. Last year, 66,000 cancer patients waited more than two months for their first treatment following an urgent GP referral, and the UK now has the worst cancer survival rate in the G7. Labour will give the NHS the staff, the technology and the reform it needs, and we make no apologies for expecting cancer waiting times and diagnosis targets to be met once again. That is our mission. Why is theirs so unambitious?

Steve Barclay: We are making significant progress. The hon. Gentleman specifically mentions GP referrals, and there were more than 11,000 urgent GP referrals for suspected cancer per working day in March 2023, compared with just under 9,500 in March 2019, so we are seeing more patients.
Let me give an indication of how we are innovating on cancer. We have doubled the number of community lung trucks, which means the detection of lung cancer at stages 1 and 2 is up by a third in areas with the highest smoking rates. In the most deprived areas, we are detecting cancer much sooner, and survival rates are, in turn, showing a marked improvement.

Healthcare for Women

Judith Cummins: What steps he is taking to improve healthcare for women.

Sarah Owen: What steps he is taking to improve healthcare for women.

Maria Caulfield: This is the first Government to produce a women’s health strategy in England. We are making huge progress on the eight priorities in our first year, from introducing the hormone replacement therapy pre-payment certificate, which is reducing the cost of HRT for women, to the £25 million roll-out of women’s health hubs across the country. We will be announcing our second-year priorities in due course.

Judith Cummins: Half of all women over 50 will experience bone fractures due to osteoporosis, and many of these will be serious hip fractures. As many women will die from these fractures as from lung cancer or  diabetes. Can the Minister explain why not even one of the 63 key performance indicators set by NHS England for integrated care boards sets a target for fracture prevention?

Maria Caulfield: I thank the hon. Lady for her work in this space. She is campaigning hard on this issue. I reassure her that osteoporosis is in the women’s health strategy and is a priority area for us. We are already working to make sure that women’s vitamin D status is known, and to make sure that we fill gaps. NHS England is expanding fracture services for high-risk women with osteoporosis, and it is working to prevent falls. The women’s health ambassador is raising the profile of osteoporosis so that women who are at higher risk can take action to prevent fractures and falls in the first place.

Sarah Owen: Women too often struggle with needless pain through standard but invasive procedures, such as hysteroscopies and intrauterine device fittings, offered without any pain relief. Our pain is being misunderstood and ignored. How much unnecessary pain must Ministers see women endure before the Government finally deliver on the pain management promised in the women’s health strategy? And why is this a 10-year ambition instead of a more immediate one?

Maria Caulfield: I thank the hon. Lady for her question, and let me also pay tribute to the hon. Member for West Ham (Ms Brown), who has campaigned hard in this space. I met a group of women to discuss painful hysteroscopies just a few weeks ago. This is a priority in the women’s health strategy, as the hon. Member for Luton North (Sarah Owen) said. We are working with the royal college to update its guidelines, because a lot of these issues are associated with women’s consent, the provision of information before these procedures, and women knowing that they can have them under a local or general anaesthetic and can also ask for pain control. This is not working in practice, which is why it is a priority in the women’s health strategy.

Lindsay Hoyle: I call the Chair of the Select Committee.

Steve Brine: Women living with HIV of course have the right to healthcare on the same terms as anyone else, except that now they do not when it comes to starting a family. Many people living with HIV are currently excluded from accessing fertility treatment, both by law and by the Government’s microbiological safety guidelines. So will the Government now follow the scientific evidence, particularly on undetectable viral load, and remove what are surely discriminatory restrictions on the basis of HIV status?

Maria Caulfield: I thank the Chair of the Health and Social Care Committee for his question, as he raises an important point. Last year, we asked the Advisory Committee on the Safety of Blood, Tissues and Organs to reconsider this specific issue. It set up a working group in June last year to look at it and we expect its recommendations this month. We will take them seriously and address them swiftly once we have its advice.

Siobhan Baillie: So many women’s health issues begin with birth and pregnancy, as health is often dependent on the care and aftercare that women receive. Will my hon. Friend give the House an update   on the recruitment of midwives and maternity teams, as Gloucestershire NHS is working so hard on that, in order to fully reopen Stroud Maternity Hospital?

Maria Caulfield: I thank my hon. Friend, who does a huge amount of work supporting her local midwives in Stroud. I can give her encouraging news: not only have we spent £190 million on midwifery services, but we are seeing an increased number of midwives coming through midwifery training. Excitingly, we have a nurse conversion course, which takes 18 months, with NHS England paying the tuition fees for nurses to convert to being midwives. We have had 300 in training this year and we are expanding that to 500 in the next academic year. We have encouraging retention rates too, which show that midwives are not only joining the profession, but staying in it.

Lindsay Hoyle: I call the shadow Minister.

Liz Kendall: There is a particular group of women whose health needs should be highlighted during Carers Week: women who look after an older or disabled relative. The majority of unpaid carers in their 50s and 60s are women. Eight million unpaid carers have seen their own health suffer, with those providing high levels of care twice as likely to have poor health as people without caring responsibilities. So will the Minister finally commit to a cross-Government national carers strategy, including health issues in it, as the last Labour Government did? That is a key demand during this year’s Carers Week.

Maria Caulfield: I thank the shadow Minister for her question. My colleague the Minister for Social Care is hosting an event today for carers, and £300 million for carers in the better care fund has also been released. I am a carer for my dad, who thankfully is well and spritely, so I understand the pressures of this. Recently, I met carers from Kinship; often they are grandparents, and older aunts and uncles, who look after young children. Work is going on between us and the Department for Education on how we can better support kinship carers, who do fantastic work in looking after young children. We fully recognise the issue, and the Social Care Minister is not just providing funding, but meeting those carers to see how we can better support them.

Arthritis: Treatment Waiting Times

Neil Coyle: What steps he is taking to improve the health of patients with arthritis awaiting NHS treatment.

Helen Whately: NHS England has drawn on the work of Versus Arthritis, including its joint replacement support package, in the resources it provides to support people waiting for hip and knee replacements. Alongside that, we know that what people really want is faster treatment. That is why we are working so hard to cut waiting lists, which is one of the Prime Minister’s five key priorities.

Neil Coyle: I am glad that the Minister referenced Versus Arthritis, because it does great work, but it has significant concerns about the waits for treatment for people living with arthritis. While recognising the efforts of hard-working NHS staff, there are more than 800,000 people in England waiting for trauma and orthopaedic treatment, including  more than 5,500 Southwark constituents waiting for treatment at Guy’s and St Tommy’s hospitals. Will the Minister meet staff from Versus Arthritis specifically to discuss how to better support people waiting for those treatments?

Helen Whately: As the hon. Member said, Versus Arthritis is doing really important work not only supporting people with arthritis while they wait for treatment, but better preparing them for surgery. What is really important, as I said a moment ago, is reducing those waits and the work that we are doing on that. We have already virtually eliminated two-year waits, and 18-month waits have been reduced by more than 90%, which is quite a contrast, we know, to the performance of the Labour-run NHS in Wales. I encourage Versus Arthritis to contribute to our call for evidence on the major conditions strategy where we are looking at what more we can do to support people with, among other things, muscular skeletal conditions.

Primary Health Care Facility: East Sefton

Bill Esterson: Whether he plans to provide funding for a new primary health care facility in East Sefton.

Neil O'Brien: The Government are providing record levels of capital to the NHS, with more than £24 billion allocated between 2022-23 and 2024-25, over £12 billion of which is allocated to integrated care boards themselves to invest in local priorities, including primary care facilities, of which just under £700 million has been allocated to NHS Cheshire and Merseyside integrated care board.

Bill Esterson: The Minister has just reminded us that the allocations are made by Government to integrated care boards. The problem is that, with a board the size of Cheshire and Merseyside, there are very many competing priorities. Sefton Council has secured more than £1 million from developers for a new health centre in East Sefton. The Health Secretary’s recent predecessors, of which there have been many, have agreed with me that a new health centre there is a priority. Will he and his colleagues match the priority accorded to this by their predecessors, match the ambition of my constituents and support the commitment by Sefton Council and award that additional funding, so that my constituents can get that much-needed health centre in East Sefton?

Neil O'Brien: The hon. Member has been campaigning doggedly for this for several years, and I am sure that his local ICB will be strongly seized of that and the strong arguments for it. He raised the issue of developer contributions. One thing that we have done in the most recent primary care recovery plan is set further steps to increase investment from developer contributions so that we match new housing with the much-needed infrastructure, such as primary care facilities.

GP Appointments

Gordon Henderson: What progress his Department has made on increasing the number of available GP appointments.

Neil O'Brien: We are taking action to increase the workforce in general practice. We have managed to hit our target of recruiting 26,000 extra clinicians a year earlier. In fact, we have 29,000 extra clinicians in GP surgeries as well as nearly 2,000 more doctors. Of course, we will go further: as well as increasing the training of GPs to a record level—up from about 2,600 to 4,000 a year—we are also taking action to improve technology to take the burden of bureaucracy off GPs through our primary care recovery plan.

Gordon Henderson: Although I appreciate the Minister’s response, Sittingbourne and Sheppey still has one of the highest patient to GP ratios in the country. Without more GPs, no initiative to increase appointments will succeed. Our local integrated care board is doing its best to bring more doctors to our area. What help can my hon. Friend give to the ICBs so that they can provide my constituents with the GPs they need?

Neil O'Brien: My hon. Friend is quite right that we absolutely need to go further. That is why, through the primary care recovery plan, we are taking some of the pressure off general practice, investing £645 million in the new Pharmacy First service, which will free up about 10 million GP appointments a year. That is why we are investing about £60,000 per practice in new IT and modern online systems. None the less, he is totally right: we need those doctors in general practice. We have about 2,000 more now than we did in 2019, but we will go further. We have already increased GP training and we are looking at building on that further.

Debbie Abrahams: Can the Minister clarify when Oldham will receive its share of the 6,000 additional GPs that were promised in the Conservative 2019 general election manifesto? Today we are running with fewer GPs, and that is not helpful to anyone.

Neil O'Brien: I have already noted that we have increased the number of doctors in general practice by nearly 2,000 since 2019 alone. The number of direct patient-facing staff in general practice is 50% higher in total than in 2019, and that is up right across the country. However, of course we will go further and grow the number of clinicians in general practice, building on what we have already done.

Matt Warman: The primary care recovery plan includes excellent measures to extend visas for international medical graduates, but can my hon. Friend say whether that extension will be automatic, answering the concerns of the Royal College of General Practitioners, and whether it will be in place for the 1,000 or so graduates coming this June and August?

Neil O'Brien: My hon. Friend modestly does not mention his role in advocating for that important reform, which will help to increase the number of highly qualified GPs coming from other countries to work in the NHS. We will ensure that that extension is automatic, so that people have extra time to make sure they get the right placement in general practice.

Tim Farron: There was a net loss of 577 full-time equivalent GPs last year. A contributing factor in rural communities was the Government’s decision a few years ago to remove the minimum practice income guarantee, making it unsustainable for small surgeries—and many rural surgeries are necessarily small—to survive. Will the Minister consider whether it is time to reintroduce a strategic small surgeries fund, to allow smaller rural surgeries in communities such as mine to survive and thrive?

Neil O'Brien: The funding formula already takes account of rurality. I hear the hon. Gentleman’s argument, but it is worth noting that our GPs are doing more than ever before. In the year to April there were nearly 10% more appointments than before the pandemic, or 20 more appointments in every GP practice per working day. GPs are working incredibly hard, as well as putting in extra staff, and I pay tribute to them for the sheer amount of work they are doing.

Paul Bristow: The Minister recently joined me at the Thistlemoor medical centre at the heart of my constituency. Led by the inspirational Modha family, the team prioritise making face-to-face appointments available for patients by having amazing admin and support staff who speak a variety of languages. That means that, by the time the patient sees the GP, all the relevant checks have been done and the GP has all the relevant information. How can we better use admin and support staff at GP surgeries so that doctors can maximise their time and operate at the very top of their licences?

Neil O'Brien: It was an absolute pleasure to meet the Modha family and see the inspirational work happening in my hon. Friend’s constituency. In our primary care recovery plan we are learning some lessons from that work, particularly about focusing GPs’ time on the jobs only they can do—hence the investment in the extra 29,000 additional roles reimbursement scheme staff, the detailed plan in the primary care recovery plan to improve communication between hospitals and GPs, the cutting back of unnecessary bureaucracy, and the freeing up of resources by simplifying the investment and impact fund and the quality and outcomes framework. It is brilliant to learn from the inspirational work happening in his constituency.

Patricia Gibson: Recent research from the Nuffield Trust shows that Brexit—a Brexit supported by both the Government and the Labour party, it has to be said—has worsened the shortage of NHS staff across the UK. Indeed, it has led to more than 4,000 European doctors choosing not to work in the national health services across the UK, due to higher costs, increased bureaucracy and uncertainty over visas. Can the Minister tell me whether that is one of the success stories of Brexit that we keep hearing about?

Neil O'Brien: International recruitment is up. In fact, we have 38,000 more doctors and 54,000 more nurses in the NHS than in 2010. In England at least, we are taking every step we can to draw on that international talent and we are using it to grow staffing in the NHS.

Lindsay Hoyle: I call the shadow Minister.

Karin Smyth: From Sittingbourne via Bristol and Oldham, people are fed up with not being able to speak with a GP when they need to. GPs are warning that rising demand and increased costs may lead to workforce cuts or even closures. They are fed up with the bamboozling of numbers—more of which we have heard this morning—whether on GPs, full-time trainees, locums and now appointments. Whatever the metric, can the Secretary of State or the Minister tell us how many more GPs or GP appointments they think are necessary for people to access the care that they need?

Neil O'Brien: We committed in our manifesto to increasing the number and availability of appointments by 50 million. We are well on our way to meeting that target, as I have mentioned—we had 10% more appointments in the year to April than in the year before the pandemic. That is the result of the additional staffing that we are putting in: the extra 29,000 other clinicians and the nearly 2,000 more doctors in general practice. We have made that investment, but the reason why GPs are doing more appointments is not just that we have provided a fifth more funding since 2017 up to 2021; it is also that GP teams are working incredibly hard, and I pay tribute to them for all they are doing.

New Hospitals and Health Centres: Funding

Luke Hall: What steps he is taking to provide funding for new hospitals and health centres.

Steve Barclay: We are investing record sums in the NHS estate, with more than £20 billion in the largest hospital building programme and, in addition, a further £1 billion to put an extra 5,000 bed capacity into NHS trusts, and more than £5 billion as part of our elective recovery plan, including for diagnostic centres and new surgical hubs.

Luke Hall: The Secretary of State is aware of the £30 million bid that we have submitted to redevelop Thornbury health centre. That new facility would provide GP appointments, more out-patient services, more mental health support and a proactive frailty hub to keep elderly residents in their homes for longer with the support that they need. Thornbury is a growing town and it desperately needs the new facility. Can the Secretary of State update me on the timescales for the outcome of our bid, and will he meet me to discuss it in more detail?

Steve Barclay: I know that is an extremely important scheme. My hon. Friend will know that the costs have risen considerably from when it was first proposed, and it is therefore right that we look at embracing modern methods of construction and at whether a rebuild option is the way forward. I am very happy to meet him to discuss it.

Mohammad Yasin: The Government have failed to support the East London NHS Foundation Trust’s bid for a new hospital, despite the fact that it has the capital to build the much-needed Bedford health village. We have a mental ill-health epidemic among adults and children. Does the Minister agree that it is reckless to expect my constituents to wait many months and to travel miles to access in-patient mental health services?

Steve Barclay: The hon. Gentleman might have missed in the announcement we made a couple of weeks ago that we are building three new mental health hospitals as part of the hospital building programme. That is also a part of our wider support for mental health, including the extra £2.3 billion of funding compared with four years ago.

Boris Johnson: May I thank my right hon. Friend for the rapid progress he is making on the hospital building programme? Can he confirm that he will shortly be announcing a full and final programme of funding so that we can deliver a superb new state-of-the-art hospital in Hillingdon, where, I am proud to say, enabling works are already under way?

Steve Barclay: I am delighted to hear that the enabling works are under way. I know that my right hon. Friend has championed both Hillingdon and the new hospital building programme. I am sure that he will welcome the investment of more than £20 billion. I can confirm that Hillingdon will be fully funded. In addition to the enabling works, we are working closely with the trust to incorporate the Hospital 2.0 design into Hillingdon, as we will at Whipps Cross, as part of taking that programme forward.

Cat Smith: When will the Government announce capital funding for the new hospital in Lancaster: before or after 2030?

Lindsay Hoyle: And Chorley, of course.

Steve Barclay: Chorley is extremely important, Mr Speaker—I am very sighted on that.
Our commitment is that that is part of the new hospital building programme. We said that it is part of the rolling programme, so it will not be completed by 2030 but we are keen to get work started on it, and that is exactly what we will be discussing with Members of Parliament in the weeks ahead.

Dental Recovery Plan

Anthony Mangnall: When he plans to publish a dental recovery plan.

Neil O'Brien: Our dental plan will be out shortly. We are already taking steps to reform the contract. We have created more bands for units of dental activity, to better reflect the fair cost of work and to incentivise NHS work. We have introduced a minimum UDA value to sustain practice where it is low, allowing dentists to deliver 110% of their UDAs. As a result, the amount of dental activity being delivered is up by about a fifth on a year ago, but we know that we must go further.

Anthony Mangnall: I welcome the Minister’s response and his comments in a recent Westminster Hall debate. It is clear that there is still a problem, and many of us are still asking for the recovery plan to come forward. I am afraid that “soon” is not good enough. Nearly every single one of the NHS dentists in my constituency is either not taking on new patients or leaving the area. “Soon” needs a date. Can we have this plan either immediately or sooner?

Neil O'Brien: I was seized by the thoughtful comments that my hon. Friend made in that Westminster Hall debate. We are working on all those ideas, and the plan will be out very shortly.

Jim Shannon: I thank the Minister for his response. Would he consider encouraging more students to go into dental work by writing off student loans for those who go into NHS dental work for a five-year period—in other words, we get something back if we invest in them?

Neil O'Brien: At every stage, we are taking action to get more dentists doing NHS work. There are 6.5% more dentists doing NHS work than in 2010. The hon. Gentleman has an important idea. We are doing other things to retain NHS dentists, such as the important reforms that we made to pensions, which have helped both GPs and NHS dentists.

Improving Hospital Facilities

Luke Evans: What progress he has made on improving hospital facilities.

Steve Barclay: The Government are providing record investment in NHS hospital facilities to improve staff and patient experiences and provide extra capacity to cut waiting lists, including the more than £20 billion that we announced just under two weeks ago.

Luke Evans: I thank the Secretary of State for his serious investment in Leicestershire, with £14 million for the diagnostic centre in Hinckley and now part of that £20 billion going to Leicester Royal Infirmary, Leicester General Hospital and Glenfield Hospital, including for upgrading the car park. But there is one final part. In 2018 we had £7 million allocated to Hinckley for improvements, but due to covid and the community diagnostic centre investment, the business plan has changed to a day case unit. The money is there. Will he remove the red tape and look on this kindly and swiftly?

Steve Barclay: My hon. Friend is right to highlight the series of investments that we have made in his local area. On the specific case he raises, he will know that the business case needs regional approval, and that is currently with NHS colleagues, but I am happy to commit to him that once that is received, we will look at it very keenly.

Andrew Slaughter: How much of the reduced £20 billion for the 2030 new hospital programme, if any, is secured for Imperial College Healthcare NHS Trust hospitals, and what are the new completion dates for building works to Charing Cross, Hammersmith and St Mary’s hospitals, now that they have been removed from the list of projects to be completed by 2030?

Steve Barclay: As I set out in my statement, there are three schemes within the trust proposal. That is part of the rolling new hospital programme. We are keen to get the enabling works started as soon as possible. That includes a decant at Charing Cross to enable floor-by-floor refurbishment to proceed. We also need to discuss with  the trust potential sites for St Mary’s. There is a considerable amount of work to be done, but we are keen to get that enabling work done as soon as possible.

Justin Tomlinson: I warmly welcome the works beginning on the new £26 million A&E facility in Swindon, hot on the heels of the £23 million urgent care and radiotherapy centres. Will the Secretary of State confirm that this is the single largest investment in Swindon healthcare facilities?

Steve Barclay: I am very happy to confirm that it is the largest investment in Swindon facilities. My hon. Friend is right to draw the House’s attention to the £26 million investment in A&E and the £23 million investment in radiotherapy. It is a tribute to his championing of the need for those facilities in Swindon that the NHS has responded and this capital funding has been provided.

Alex Cunningham: I have seen the wide smiles in the pictures of the Prime Minister, former Health Secretary and other MPs who have been happy to visit North Tees hospital in my constituency, where health inequalities are some of the worst in the country. They know that it is not fit for purpose, so why on earth have the Prime Minister and his Health Secretary turned their backs on the dedicated staff there and rejected their bid to replace our rundown hospital?

Steve Barclay: The hon. Gentleman seems to have missed the £12 billion record investment in capital across the NHS, the investment in the NHS app, the investment in tech—

Alex Cunningham: That is not North Tees. You cancelled it 13 years ago.

Steve Barclay: No, the technology programmes are national programmes that cover everyone, including North Tees. It is slightly odd to suggest that one place alone in the country would be exempt from a national programme; that is simply not the case. We are making record investment, including over £20 billion in the new hospital programme and 160 diagnostic centres and 43 new surgical hubs this year.

Topical Questions

Sarah Owen: If he will make a statement on his departmental responsibilities.

Steve Barclay: As Health Secretary, I have been clear that deploying the latest technology and innovation is essential in order to deliver our priorities: to cut waiting lists, improve access to GPs and improve A&E performance. The NHS app is at the heart of this, including the enhancement of patient choice set out in our recent announcement, which is not available to patients in Wales. The Patients Association estimates that by enabling people to select a different hospital in the same region on the app, we can cut their waiting times by as much as three months.
We have been making major improvements behind the scenes, which are already paying off. Today, I can tell the House that between March 2022 and March of this year, there have been 6 million new registrations for  the app; repeat prescriptions via the app have increased from 1.6 million a month to 2.5 million a month; and primary care appointments made on the app have increased from 30,000 a month to 250,000, and secondary care appointment from 30,000 a month to 360,000. We continue to work to increase the app’s functionality, including opening more records and test results and enabling more appointments, as part of our commitment to technology.

Lindsay Hoyle: I think a statement would be better next time.

Sarah Owen: Brain tumours are the biggest killer for people under 40, but we are still waiting for the full £40 million that the Government promised to fund brain tumour research. In March, I raised in the House the heartbreaking experience of my constituents Yasmin and Khuram, whose daughter Amani died from a brain tumour just before her 23rd birthday. Once again, I ask whether the Minister for Health and Secondary Care or the Secretary of State will meet with me and my constituents to hear their calls for the full funding allocation  to be given to researchers. That funding would be transformational for the treatment of brain tumours.

Steve Barclay: The Minister of State has met with campaigners, and I know he stands ready to have further such meetings. As we touched on earlier, the £40 million is available; obviously, that needs to be allocated to research bids of the necessary quality, and the remaining money is open to researchers to bid for. I hope they will do so.

Selaine Saxby: I thank my right hon. Friend for reconfirming the investment into North Devon District Hospital. Will he meet with me, the hospital trust and my local housing association to ensure that the housing committed to on the Barnstaple site can rapidly commence?

Steve Barclay: I am very keen to meet with my hon. Friend. I know this is an extremely important scheme for her constituency, particularly the key worker accommodation, and I look forward to having that discussion with her and the leadership of her trust.

Lindsay Hoyle: I call the shadow Secretary of State.

Wes Streeting: First, I congratulate the Health Secretary on his recent write-up as the next Leader of the Opposition. According to the i newspaper, his supporters are calling him “Mr Consistent”. Is that because of the consistent rise in waiting lists since he became Health Secretary, the consistently longer waiting times that patients are facing, or the consistent delay to the NHS workforce plan?

Steve Barclay: The point of consistency is that we gave a manifesto commitment to have 26,000 additional roles in primary care, and we have delivered that. We made a commitment to the largest ever hospital building programme, and we have announced over £20 billion of investment in it. The Government are standing by their manifesto commitments—that is what we are delivering.

Wes Streeting: I am sure that will do it.
I want to turn to the most recent reports about the NHS workforce plan, because apparently not only is that plan delayed, but we now read in the media that it is unfunded. Labour will pay for our workforce plan by abolishing the non-dom tax status. [Interruption.] Conservative Members do not like it, Mr Speaker, but it is the only tax they have been unwilling to put up. We have a plan, and we have said how we will pay for it. How will the Health Secretary fund his plan when it eventually arrives? Will it be cuts to the NHS, more borrowing, or even more broken promises?

Steve Barclay: The hon. Gentleman is recycling this question almost as often as he recycles the non-dom funding. As I said at the last Health and Social Care Question Time, it is like the 1p on income tax that the Lib Dems used to promise, which was applied to every scheme going.
We touched on this issue at the last Question Time, and indeed at the one before: we have a commitment to a long-term workforce plan. The Chancellor made that commitment in the autumn statement, but it is a complex piece of work that NHS England is working on. It is important that we get the reforms in that plan right, and that is what we are committed to doing.

Maggie Throup: Just a couple of weeks ago, the Obesity Health Alliance launched its manifesto to tackle the high levels of diet-related ill health and the impact that has on our economy and society. Can my hon. Friend update the House on the progress being made on implementing the measures in section 172 of and schedule 18 to the Health and Care Act 2022 on the advertising of less healthy food and drink?

Neil O'Brien: We are still committed to reducing the advertising of unhealthy food, including the junk food watershed that will be implemented in 2025. Ahead of that, we are taking action on obesity across the board, including the sugar tax, which has cut the average sugar content of affected drinks by 46%, the calorie labelling that we have on out-of-home food in cafés and restaurants, and the location restrictions on less healthy food that are coming in from October.

Lindsay Hoyle: I call the SNP spokesperson.

Martyn Day: Kidney Research UK has published a report on the health economics of kidney disease, predicting a terrifying rise over the next 10 years. As we know, uncontrolled diabetes is the biggest cause, with Diabetes UK noting that those disproportionately most at risk are those from poverty and from south Asian and black ethnic backgrounds. Reducing health inequalities is therefore key, and it is a key ambition for the Scottish Government. It means tackling poverty in our society. What steps is the Minister’s Department—

Lindsay Hoyle: Order. This is topicals.

Martyn Day: It is topical because the research was just published yesterday.

Lindsay Hoyle: The question cannot go on forever; let us get an answer.

Neil O'Brien: I had a useful conversation with the Scottish public health Minister where we discussed many of these issues. We are providing huge cost of living support—some of the most generous in Europe, worth £3,300 a household—and taking action across the piece. Whether it is smoking or obesity, we are tackling the underlying causes of the health inequalities that the hon. Gentleman mentions.

Edward Leigh: Under the Human Rights Act, do the Government not have a duty of care to deal with the housing of illegal migrants? How can the Government ensure the  health of 2,000 migrants cooped up in the former RAF Scampton? In particular, how will they ensure their health given the fact that the site is riddled with asbestos and contamination from 100 years of RAF usage? I see a case coming to the European Court of Human Rights.

Steve Barclay: Clearly, an increase in population in a specific area will have an impact on the health needs there. I recognise the concern that my right hon. Friend raises, and I will ask the Minister for Primary Care and Public Health to follow up with him on this important point. While the NHS is well equipped to deal with short-term pressures, this issue highlights the importance of the Prime Minister’s commitment to stop the boats and the Government’s overall strategy on illegal migration.

Lisa Cameron: As chair of the all-party parliamentary health group, I have been hearing so much about the importance of artificial intelligence innovation in mental health, and I was pleased to launch the AVATAR2 clinical trials in three universities across the UK. Will the Secretary of State commend this progress being made in digital innovation? It deserves scrutiny, but can make much progress.

Steve Barclay: I very much welcome it. I am delighted to hear that constructive approach to AI from the hon. Lady. The importance of AI is why we have been funding more than 80 AI lab schemes with more than £130 million. AI has huge potential to help patients. We are seeing that, for example, in stroke patients getting care much quicker. She is right that there are also some regulatory and other issues that we need to address, but we should not miss the opportunities of AI, and she is right to highlight them.

Anna Firth: Last week, not a single dentist across the city of Southend said that they were taking on new NHS patients, which is concerning for my constituents. Can my hon. Friend confirm again what steps he is taking to make sure that my constituents get the NHS dental treatment that they deserve?

Neil O'Brien: This is absolutely the top priority I am working on at the moment. I am totally seized of the challenge that my hon. Friend mentions. I have mentioned some of the reforms we are already making, which have  increased dental activity by about a fifth in the year to March, but we know that we have to go further and we will do so shortly.

Nadia Whittome: More than one in 10 social care roles are vacant, and the biggest culprit in this recruitment and retention crisis is low pay. According to recent TUC analysis, a £15 an hour minimum wage for care workers would not only tackle staff shortages, but level up places such  as the east midlands, introducing an £800 million economic boost. Will the Government introduce that?

Helen Whately: I want to see the care workforce recognised and rewarded for the work that they do. That is one reason why we gave adult social care a record uplift to its funding of up to £7.5 billion in the autumn statement, for local authorities to fund care providers to pay their workforce in turn. That goes hand in hand with our workforce reforms to develop the skills and career opportunities for the care workforce.

Christopher Chope: Has my right hon. Friend the Secretary of State read the report “Safe and Effective?” produced in April by a group of senior clinicians, which is very critical of the work of the Medicines and Healthcare products Regulatory Agency? If he has not yet read it, will he do so, please?

Maria Caulfield: I thank my hon. Friend for his question. I feel that we had a  very productive meeting yesterday with the all-party parliamentary group on covid-19 vaccine damage about the vaccines for covid and the issue of the MHRA. He raised a number of important points during that meeting, including that on the MHRA, and I will be responding to him shortly.

Ellie Reeves: One of my constituents with complex health needs has struggled to get GP appointments for years now. On one occasion when they could not get an appointment, they had to resort to taking out-of-date medicine. Last week, they phoned every morning at 8 am, before finally getting just a telephone appointment. When will the Government finally fix the crisis in primary care and make sure that everyone gets access to a GP appointment?

Steve Barclay: As the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough, said earlier, through the primary care recovery plan we have specific measures to tackle things such as the pressure at 8 am, particularly on a Monday morning. There is the investment in digital telephony, with call-back features, and online booking, as well as the channel shift to enable pharmacists to do more and to prescribe more, the use of the NHS app and the review of 111. There is a range of initiatives that we are taking to address the increased demand. Ultimately, GPs are seeing more patients—up to 10% more patients—but there is more demand, and that is how we are meeting it.

Philip Hollobone: Kettering General Hospital is aiming to submit its final business case for its £34 million net zero energy centre in December, but has been told that when it does so, it can expect at least a 13-week wait for approval. The Secretary of State has been good enough to see for himself the urgent need for this new power plant. Is there anything he can do to speed up this process?

Steve Barclay: I share my hon. Friend’s desire for us to move at pace on the scheme. As he says, I have seen at first hand the importance of the scheme at Kettering, and I stand ready to work constructively with him to expedite that case, because I do not think anyone is in any doubt of the importance of the work at Kettering. It is a huge tribute to him and the way he has championed the case for Kettering that it was such a central part of the new hospital programme announcement.

Simon Lightwood: In Wakefield, I am pleased to say that our campaign to save our city centre walk-in service has been successful, but every day people are still struggling to get a GP appointment. The latest NHS statistics show that, in April, 12,586 people waited more than 28 days. Quite simply, there are not enough fully qualified GPs. Labour has a workforce plan that is ambitious and costed. Where is the Government’s delayed and fully funded workforce plan?

Neil O'Brien: I have already mentioned that we have nearly 2,000 more doctors in primary care than we did in 2019, as well as the early delivery of the 26,000 extra clinicians we have brought into primary care. [Interruption.] The Opposition may not want to hear it, but the truth is that we have increased funding for general practice by about a fifth in real terms. We have more doctors and other clinicians, and GPs are doing 10% more appointments every month. We want to continue to build on that, which is why we have the primary care recovery plan and why we have invested a further £645 million in enabling people to get treatment from their pharmacists, freeing up 10 million more GP appointments. We know we must go further, but we are making progress.

Aaron Bell: I know the Minister is very keen to see the numbers of elective waits fall, and they have been falling. My constituents in Newcastle-under-Lyme share that aim. So will he welcome the local hospital trust opening not only a new modular theatre for specialised hand surgery, but a central treatment suite for day patients at the County Hospital in Stafford funded by NHS England’s elective recovery plan, which will help cut waits for planned procedures?

Will Quince: I thank my hon. Friend for his question. He has articulately and eloquently set out the improvements being made at Stafford County Hospital, and he has been a strong champion for those works. This is real, visible, positive change that will benefit both residents and patients in Newcastle-under-Lyme and the surrounding areas.

Stewart McDonald: My constituent Brian Murray lost his wife Roberta six years ago, following years of chronic health conditions  after an infected blood transfusion. He wants to know: when will the Government enact all of the recommendations regarding compensation from the second report by Sir Brian Langstaff?

Maria Caulfield: I thank the hon. Gentleman for his question. We take this issue very seriously, and we have already made interim payments to those infected. The Minister for the Cabinet Office came to the Dispatch Box in April when Brian Langstaff’s review was published, and we are working night and day to respond to those recommendations and get that plan out as soon as possible. We recognise the impact on families, and on those infected and affected.

Dr Caroline Johnson: I refer Members to my entry in the Register of Members’ Financial Interests. Today Dr Mike McKean, a respiratory consultant and vice-president of the Royal College of Paediatrics and Child Health, said that vaping is “fast becoming an epidemic” among children. The Royal College of Paediatrics and Child Health said that we should ban disposable cigarettes—e-cigarettes—“without a doubt”. Will the Minister do all he can to prevent children from starting vaping, and will he back my ten-minute rule Bill, which was first introduced in this place in February, to ban disposable e-cigarettes?

Neil O'Brien: I pay tribute to my hon. Friend and her leadership on this issue. Many of the ideas that she has been putting forward are already in the plan that we set out to tackle youth vaping, including the creation of the “flying squad”, the ongoing call for evidence on youth vaping, and all the different things we could do to continue to drive it down.

Stephanie Peacock: The non-surgical breast cancer service in South Yorkshire is facing a critical shortage of oncologists. The shortage is so severe that patients are being told to expect months between referral and appointment. What immediate steps are the Government taking to ensure that patients, no matter their postcode, see a specialist as soon as they need to do so?

Steve Barclay: As reflected in the fact that we met the faster diagnosis standard in February and March for the first time, we are investing more in our cancer services to meet the recognised increase in demand. That is why more patients are being treated sooner and survival rates are improving. I am happy to look at any variation at a local level because of workforce pressure, but the diagnostic centres and surgical hubs are all part of our response to the increase in cancer demand.

Jack Brereton: A number of dentists across north Staffordshire are stopping NHS treatment, which is extremely concerning. Some of my constituents have reported that they are being told they will have to pay either £120 a year or £14 a month to stay on the books. Will my hon. Friend look into those serious concerns and meet me to discuss the matter further?

Neil O'Brien: I am happy to meet my hon. Friend to discuss those important issues further.

Daisy Cooper: I recently learned that my local integrated care board is not allowed to spend the money it wants to spend on securing the best location for a new GP practice and health centre. The reason is that Treasury rules, which are used by the District Valuer Services, are not keeping up with market rents. Will the Secretary of State speak to his colleagues  in the Treasury to fix that, before we face an epidemic of health centres and GPs leaving town and city centres, and moving to ring-road locations away from the populations they serve?

Steve Barclay: I am very happy to look at that specific issue and raise it with Treasury colleagues.

Point of Order

Christopher Chope: On a point of order, Mr Speaker. You were in the Chair yesterday when the Secretary of State for Levelling Up, Housing and Communities expressed his enthusiasm for the publication of impact assessments for new legislation. The Renters (Reform) Bill is awaiting Second Reading, and there are two impact assessments, neither of which have yet been made available to Members of the House. What can be done to ensure that they are made available before we have Second Reading?

Lindsay Hoyle: The good thing is that you have certainly put that on the record. I am sure that those on the Treasury Bench are listening carefully, and will be knocking at your door when you get back. I would expect those impact studies to be made available.

Bill Presented

Pets (Theft and Importation) Bill

Presentation and First Reading (Standing Order No. 57)
Tim Farron, supported by Richard Foord, Ed Davey, Wendy Chamberlain, Sarah Olney, Munira Wilson, Christine Jardine and Wera Hobhouse, presented a Bill to prevent and punish the theft of dogs and to deter the unlawful importation of certain animals into Great Britain; and for connected purposes.
Bill read the First time; to be read a Second time Friday 24 November, and to be printed (Bill 317).

Care Supporters

Motion for leave to bring in a Bill (Standing Order No. 23)

Dan Carden: I beg to move,
That leave be given to bring in a Bill to provide for a right for a user of health and care services to be accompanied by a care supporter; and for connected purposes.
The care of a loved one is not an optional extra; it is an absolutely central part of dignified care. Separation and isolation have a deeply harmful impact on individuals, but particularly on those who are vulnerable. For those who are approaching the end of life, the impact cannot be understated. My Bill seeks to recognise those fundamental points, and put them into law.
Throughout the pandemic, guidance proved consistently inadequate. It applied with levels of uncertainty and variability that led to a postcode lottery as separate settings interpreted it differently. There is a clear lack of recourse when guidance is applied incorrectly as well as a wide power imbalance between service users and care providers. Those problems will not be solved through further tweaks to guidance.
Past practice has shown that older and disabled people, those affected by dementia, stroke and other impairments, and those with a mental or physical disability are some of the most powerless people in our society. They often do not have the ability to challenge decisions made at care homes or in hospitals. In the worst circumstances—these are not uncommon—they cannot defend themselves against abuse, neglect or inhumane conditions.
The devastating impact of all of that affects not only those in receipt of care but their loved ones. Further, poor-quality data on visiting means that we cannot appreciate the true scale of the problem. Data does not capture where visits are allowed only for a short period of time, where young people are disallowed from visiting or where people cannot see parents, husbands or wives directly in their rooms. There is also a principle at stake: do we as a society give the right to state or private institutions—namely, hospitals and care homes—to deny us contact with family and loved ones because they are in receipt of their care, or do we believe that we should keep our right to maintain contact with loved ones regardless of health and care needs? I think it is obvious. I firmly believe that we should make a clear choice of the latter and enshrine that right in law in this House.
There is a dangerous hangover of restrictions from covid and a lack of urgency from the Government to change things. The need for the Bill is therefore as pivotal as it was during the pandemic.
Before I turn to the steps that I have taken to put this measure into law, I pay tribute to the determined efforts of campaigning organisations in this area: in particular, the Rights for Residents campaign group and the Relatives and Residents Association, which have merged to become Care Rights UK, and John’s Campaign. The work of Jenny Morrison, Diane Mayhew, Helen Wildbore, Julia Jones, Nicci Gerrard and Kate Meacock has been inspirational. They are all in the Public Gallery watching our proceedings. I also place on record my appreciation to the hon. Members for Chatham and Aylesford (Tracey  Crouch) and for St Albans (Daisy Cooper) and the right hon. Member for Dwyfor Meirionnydd (Liz Saville Roberts), who have supported the campaign from its origin. Quite simply, I would not be introducing the Bill if it were not for their collective efforts; I thank them all for that.
In November 2021, I tabled an amendment to the Health and Care Bill that aimed to guarantee visiting rights to hospitals and care homes. The amendments were not moved, but I hoped that the Department would take note. Many people across the country spent the winter of 2021 separated from those most important to them. In March 2022, we invited those affected to an event where they could share their experiences with parliamentarians. The testimonies that we heard were harrowing and the collective trauma was palpable. That powerful event left those present united in the view that a legal right was needed to secure the right of care users to nominate an individual to provide support or care in all circumstances.
Many at the event were disappointed by the following inaction from Government. None the less, following it, 60 Members signed a letter to the right hon. Member for Bromsgrove (Sajid Javid), who was at that point Secretary of State for Health and Social Care, pushing for a legal right to be put into law. We were again left disheartened by the Department’s response, which prescribed updated guidance as the solution to any problems. However, we pressed on.
In October last year, in response to our Backbench debate, the Minister for Social Care, the hon. Member for Faversham and Mid Kent (Helen Whately), stated that she did not
“consider the status quo acceptable”—[Official Report, 27 October 2022; Vol. 721, c. 494.]
and that she was “on the case.” Those words, with the promise of action, meant a lot to those affected. Campaign groups waited to see what shape that promised action would take and I trust the Minister for Social Care has been working on the issue. She attended our meeting this morning to meet campaigners. I say to her that we now need to see action.
It is important to remember that the denial of contact has not just taken place in care homes, but in hospitals too—I can account for that from personal experience. Therefore, any legislative response must address both sides of the health and social care system. I hope that those on the Treasury Bench will hear this point. It is not just colleagues in the House but more than 70 organisations across the sector who are pressing for action in this area: Mencap, the Alzheimer’s Society,  Mind, Age UK, Care UK, Healthwatch—the list goes on. We have support from all parties across the House. In fact, I have witnessed few other issues on which there has been such universal agreement in the House.
There are only a few months left of this parliamentary Session. We expect the King’s Speech in autumn and a general election next year. It is clear that the time to act is now. Will the Government commit to legislating for a care supporter in the next King’s Speech? Will all major parties commit to putting this legal right into their manifestos? We have a Bill ready to be implemented. I thank Tom Gillie from Matrix Chambers and Carolin Ott from Leigh Day for their hugely valuable work on the draft legislation. Let me quickly outline how the Bill would operate in practice.
The Bill would place a duty on health and care providers to allow a service user to be accompanied by a care supporter. A care supporter is defined as a person nominated as such by the service user. Importantly, the right would attach to the service user, and only following their clear and informed consent. The Bill places a duty on providers to allow unrestricted in-person support from at least one essential care supporter, nominated by the service user. The Bill also provides safeguards for those exceptional circumstances in which the duty on providers would not apply. The Bill provides alternatives if the care supporter’s face-to-face access is entirely excluded. The provider would then have to take reasonable steps to facilitate contact by other means. Finally, the Bill would also provide means for appeal and proper enforcement, two measures that are currently almost impossible for those trying to maintain contact with their loved ones in care settings. As always, I stand ready to work with the Government on any steps that can be taken to make the Bill as effective as possible.
No one in this House was left untouched by the trauma of the coronavirus pandemic. We can all agree on the principle that whether it is the state, a privately run care home or a hospital, it does not have the right to separate us from our family and loved ones. We must now take the opportunity to learn from that trauma and bring in legislation.
Question put and agreed to.
Ordered,
That Dan Carden, Tracey Crouch, Daisy Cooper, Liz Saville Roberts, Marsha De Cordova, Caroline Lucas, Alicia Kearns, Hilary Benn, Maria Eagle, John Nicolson, Dame Caroline Dinenage and Steve Brine present the Bill.
Dan Carden accordingly presented the Bill.
Bill read the First time; to be read a Second time on Friday 24 November, and to be printed (Bill 318).

Committee on Standards

Motion made, and Question put forthwith (Standing Order No. 149(14)),
That this House:—
(1) approves the Ninth Report of the Committee on Standards, HC 1276;
(2) endorses the recommendation in paragraph 40; and
(3) accordingly suspends Margaret Ferrier from the service of the House for a period of 30 days, beginning on Wednesday 7 June 2023.—(Fay Jones.)

The House divided: Ayes 185, Noes 40.
Question accordingly agreed to.

British Nationality (Regularisation of Past Practice) Bill (Allocation of Time)

Ordered,
That the following provisions shall apply to the proceedings on the British Nationality (Regularisation of Past Practice) Bill—

Timetable

(1)(a) Proceedings on Second Reading and in Committee of the whole House, any proceedings on Consideration and proceedings on Third Reading shall be taken at today’s sitting in accordance with this Order.
(b) Proceedings on Second Reading shall (so far as not previously concluded) be brought to a conclusion three hours after the commencement of proceedings on the Motion for this Order.
(c) Proceedings in Committee of the whole House, any proceedings on Consideration and proceedings on Third Reading shall (so far as not previously concluded) be brought to a conclusion five hours after the commencement of proceedings on the Motion for this Order.

Timing of proceedings and Questions to be put

(2) When the Bill has been read a second time:
(a) it shall, despite Standing Order No. 63 (Committal of bills not subject to a programme order), stand committed to a Committee of the whole House without any Question being put;
(b) the Speaker shall leave the chair whether or not notice of an Instruction has been given.
(3)(a) On the conclusion of proceedings in Committee of the whole House, the Chair shall report the Bill to the House without putting any Question.
(b) If the Bill is reported with amendments, the House shall proceed to consider the Bill as amended without any Question being put.
(4) For the purpose of bringing any proceedings to a conclusion in accordance with paragraph (1), the Chair or Speaker shall forthwith put the following Questions in the same order as they would fall to be put if this Order did not apply:
(a) any Question already proposed from the chair;
(b) any Question necessary to bring to a decision a Question so proposed;
(c) the Question on any amendment moved or Motion made by a Minister of the Crown;
(d) the Question on any amendment, new Clause or new Schedule selected by the Chair or Speaker for separate decision;
(e) any other Question necessary for the disposal of the business to be concluded; and shall not put any other Questions, other than the Question on any motion described in paragraph (15)(a) of this Order.
(5) On a Motion so made for a new Clause or a new Schedule, the Chair or Speaker shall put only the Question that the Clause or Schedule be added to the Bill.
(6) If two or more Questions would fall to be put under paragraph (4)(c) on successive amendments moved or Motions made by a Minister of the Crown, the Chair or Speaker shall instead put a single Question in relation to those amendments or Motions.
(7) If two or more Questions would fall to be put under paragraph (4)(e) in relation to successive provisions of the Bill, the Chair shall instead put a single Question in relation to those provisions, except that the Question shall be put separately on any Clause of or Schedule to the Bill which a Minister of the Crown has signified an intention to leave out.

Consideration of Lords Amendments

(8)(a) Any Lords Amendments to the Bill may be considered forthwith without any Question being put; and any proceedings interrupted for that purpose shall be suspended accordingly.
(b) Proceedings on consideration of Lords Amendments shall (so far as not previously concluded) be brought to a conclusion one hour after their commencement; and any proceedings suspended under sub-paragraph (a) shall thereupon be resumed.
(9) Paragraphs (2) to (7) of Standing Order No. 83F (Programme orders: conclusion of proceedings on consideration of Lords amendments) apply for the purposes of bringing any proceedings to a conclusion in accordance with paragraph (8) of this Order.

Subsequent stages

(10)(a) Any further Message from the Lords on the Bill may be considered forthwith without any Question being put; and any proceedings interrupted for that purpose shall be suspended accordingly.
(b) Proceedings on any further Message from the Lords shall (so far as not previously concluded) be brought to a conclusion one hour after their commencement; and any proceedings suspended under sub-paragraph (a) shall thereupon be resumed.
(11) Paragraphs (2) to (5) of Standing Order No. 83G (Programme orders: conclusion of proceedings on further messages from the Lords) apply for the purposes of bringing any proceedings to a conclusion in accordance with paragraph (10) of this Order.

Reasons Committee

(12) Paragraphs (2) to (6) of Standing Order No. 83H (Programme orders: reasons committee) apply in relation to any committee to be appointed to draw up reasons after proceedings have been brought to a conclusion in accordance with this Order.

Miscellaneous

(13) Standing Order No. 15(1) (Exempted business) shall apply to proceedings on the Bill.
(14) Standing Order No. 82 (Business Committee) shall not apply in relation to any proceedings to which this Order applies.
(15)(a) No Motion shall be made, except by a Minister of the Crown, to alter the order in which any proceedings on the Bill are taken, to recommit the Bill or to vary or supplement the provisions of this
(b) No notice shall be required of such a Motion.
(c) Such a Motion may be considered forthwith without any Question being put; and any proceedings interrupted for that purpose shall be suspended accordingly.
(d) The Question on such a Motion shall be put forthwith; and any proceedings suspended under sub-paragraph (c) shall thereupon be resumed.
(e) Standing Order No. 15(1) (Exempted business) shall apply to proceedings on such a Motion.
(16)(a) No dilatory Motion shall be made in relation to proceedings to which this Order applies except by a Minister of the Crown.
(b) The Question on any such Motion shall be put forthwith.
(17)(a) The start of any debate under Standing Order No. 24 (Emergency debates) to be held on a day on which the Bill has been set down to be taken as an Order of the Day shall be postponed until the conclusion of any proceedings on that day to which this Order applies.
(b) Standing Order No. 15(1) (Exempted business) shall apply to proceedings in respect of such a debate.
(18) Proceedings to which this Order applies shall not be interrupted under any Standing Order relating to the sittings of the House.
(19)(a) Any private business which has been set down for consideration at a time falling after the commencement of proceedings on this Order or on the Bill on a day on which the Bill has been set down to be taken as an Order of the Day shall, instead of being considered as provided by Standing Orders or by any Order of the House, be considered at the conclusion of the proceedings on the Bill on that day.
(b) Standing Order No. 15(1) (Exempted business) shall apply to the private business so far as necessary for the purpose of securing that the business may be considered for a period of three hours.—(Fay Jones.)

British Nationality  (Regularisation of Past Practice) Bill

Second Reading

Robert Jenrick: I beg to move, That the Bill be now read a Second time.
The Bill seeks to address a technical legal issue identified by the Home Office with a long-standing policy that operated from 1983 until the early 2000s under successive Governments of both parties, relating to the criteria for determining whether European economic area nationals living in the UK during that period were “settled”.
The concept of settlement is important. The British Nationality Act 1981 defines it as being ordinarily resident in the UK and without restriction on the period for which one may remain, and it is also referred to as “free from immigration time restrictions”. As many Members will know, the Act introduced changes for acquisition of citizenship, shifting from a “birth on soil” approach to a requirement for at least one parent to be British or settled in the UK at the time of the birth. Thus the issue of whether or not an individual is settled has a knock-on effect on the citizenship of any children born to that individual in the United Kingdom.

Layla Moran: I thoroughly welcome the Bill. I have a constituent who falls into this category. She had to prove her nationality, although, having lived here for 33 years—this is the only country she ever knew, and English is the only language she has ever spoken—she did not even know that she was not British until she had to apply for a passport. She was estranged from her mother, and therefore found herself having to have very painful conversations with a family member to prove that she was what she had always thought she was. Does the Minister agree that the Bill will sort out issues of that kind?

Robert Jenrick: I strongly agree with the hon. Lady. The Home Office would argue that her constituent has always been British and should be considered so, but there has been a degree of legal doubt following the recent case, so it was right that we brought forward this legislation at the earliest opportunity and that it is retrospective, so that all constituents who have been concerned can know that, clearly in law, they are and have always been British citizens.

Theresa Villiers: I warmly welcome this piece of legislation. I have a constituent whose son falls into this category and it was frankly alarming for him to be told that his citizenship was in jeopardy. It is really good that the Government have acted so swiftly and I urge everyone in the House to support this legislation. I hope that we will see it on the statute book as soon as possible.

Robert Jenrick: I am grateful to my right hon. Friend. She has raised the case to which she referred with me to represent her constituent. As she says, being a citizen of this country is an important and special status, and nobody should be in doubt about whether that is truly legally sound. The Bill puts that beyond doubt, and I am pleased that we have been able to do this expeditiously. I am grateful for her support and, I suspect, that of Members on both sides of the House today.
During the period from 1 January 1983 to 1 October 2000, individuals lawfully exercising a free movement right in England, Scotland, Wales or Northern Ireland—for example, as workers—were considered by the Home Office to be free from immigration time restrictions. Consequently, they were treated as settled for nationality purposes and any children born to them during that period were regarded as British citizens. This interpretation was supported by Home Office policy documents and guidance.
However, as I have just referenced, recent litigation, while not directly challenging that historical approach, has exposed a legal technicality suggesting that it was not correct and that EEA nationals in exercise of a free movement right were not in fact settled, as their residence should always have been deemed subject to immigration time restrictions. This has understandably led to concerns about the citizenship status of individuals born in the UK in the relevant period to parents exercising a free movement right who had always thought themselves to be British and been treated as such by successive Governments. Given the passage of time and the volumes of people potentially affected, the House will appreciate that this uncertainty is not something that we wish to countenance.

Gregory Campbell: Hopefully the Bill will proceed with support from both sides. On a directly related matter, the Minister will be aware that there are thousands of citizens across the United Kingdom, many of them in Northern Ireland, who were born a few miles across the border in the Irish Republic after 1948 but who are currently not allowed to get a British passport. Technically, even though they reside in the UK, have lived in the UK for decades, are taxpayers in the UK and vote in the UK, they cannot get a British passport without naturalising at a cost of £1,300. They have the support of the Northern Ireland Affairs Committee of this House and they have cross-community support in Northern Ireland. Once the passage of this Bill has concluded, will the Minister undertake to look again at this matter, revise it, and hopefully come forward with a proposition that will alleviate the problem?

Robert Jenrick: I am grateful to the hon. Gentleman. This is an issue that I am aware of and I would be happy to have a further conversation with him and to give it further thought. We want a fair system whereby British citizenship is available to all those who are naturalised and who have lived here for sustained periods, and a system that is as accessible as possible.
To continue the point I was making, legislating quickly and proactively to provide reassurance is the right thing to do. The Bill will operate by confirming in law the previous policy position. This will protect the nationality rights of people born in the UK to parents who were considered settled on the basis of exercising a free movement right and those who registered or naturalised as British citizens based on that policy. The Bill also clarifies when EEA nationals could be considered settled on the basis of exercising an equivalent right in Jersey, Guernsey or the Isle of Man, which are part of the United Kingdom for nationality purposes. It is right that this approach is adopted in those locations to  ensure that no one loses out on a citizenship right to which they have a reasonable expectation of being entitled, based on published policy and operational practice.

Jim Shannon: Like my hon. Friend the Member for East Londonderry (Mr Campbell), I fully support and welcome the Bill.
I am not sure whether the Minister is aware that, last week, a former leader of Sinn Féin said that, when Unionists talk to Sinn Féin about a united Ireland, it would be Sinn Féin and the Republic of Ireland that would be handing out British passports. I am very proud to have a British passport and the benefits it brings, so will the Minister put it clearly on the record today that people born in the United Kingdom of Great Britain and Northern Ireland will have a British passport; that it will be the Minister, the Government and the Department that will be handing out those passports; and that Sinn Féin and the Republic of Ireland Government will never hand out a British passport to any citizen, and nor should they?

Robert Jenrick: The hon. Gentleman makes an important point, and he is right to make that point. I will restate it for him, if that would be helpful.
I want to be clear that the Bill is not about creating new British citizens. These are people who have always considered themselves to be British, and whom successive Governments have also considered as such. They may have lived here, worked here, had children here and organised their lives based on policy published under both Conservative and Labour Governments confirming that they are British. It is essential that we provide them with legal certainty as to their citizenship status as soon as possible, so they can continue their lives in our country with the same rights and entitlements they have always enjoyed.
I think we can all agree that this short but important Bill seeks to do the right thing by putting the citizenship status of affected individuals beyond doubt, and I urge all colleagues on both sides of the House to support its quick passage.

Rosie Winterton: I call the shadow Minister.

Stephen Kinnock: I thank the Minister for that introduction and overview of the Bill. It is not often that I find myself in full agreement with him but, in this case, I am very pleased to say that we are on the same page. I am used to sparring with him—verbally, of course—on a range of topics on which we have not always seen eye to eye, but the Opposition welcome the Bill and the Government’s commitment to its expedited passage.
This is a narrow piece of legislation that addresses a specific issue. Its purpose is not to implement any changes in legal entitlements to British citizenship but, rather, to codify in primary legislation what has been the established position of successive Governments of both parties. As such, we have not seen any reason to table amendments and we are happy to work with the Government to facilitate the Bill’s swift passage and implementation.
The Bill covers individuals born in the UK to parents from EU countries between 1983 and 2000. It codifies their right to citizenship, in line with successive Governments’ understanding of the British Nationality Act 1981. Many of these people will have held a British passport for many years. However, recent litigation in the Roehrig case raised potential problems for those applying for a passport for the first time. The explanatory notes suggest that only a small number of first-time applications have been made, which the Home Office placed on hold in October 2022, as a result of the Roehrig case. The Government’s position is that the Passport Office will be able to move forward with those applications once this Bill takes effect. Beyond that, the total number of people who may be covered by this legislation remains unclear. According to the equality impact assessment:
“no official figures exist to highlight the scale of the cohort impacted. However, we have combined data from two sources to reach the conclusion that there were in the region of 167,000 children born to EEA mothers between 1983 and 2000”.
So I want to ask the Minister a few questions. I totally understand if he cannot answer all of them now, but it would be useful for the House to have some clarification. I reiterate that we are ready to support the Government in moving this Bill through Parliament as quickly  as possible. My questions are primarily on issues  of implementation, on which further detail of the Government’s plans would be helpful to the House. Given the substantial gaps in the official data available, does the Home Office have any plans to work with the Office for National Statistics to carry out further research on the number of people who may be affected, particularly in terms of first-time applicants for a British passport?
Secondly, the explanatory notes state that once the Bill is enacted, the Home Office will be in a position to resume the processing of passport applications placed on hold in October last year. Will the Minister confirm that that means the Passport Office will restart the decision-making process immediately upon the Bill’s entry into force? Thirdly, what steps does the Home Office plan to take to ensure that the individuals affected are provided with access to advice and support on their rights and, where relevant, on what action they may need to take to obtain confirmation of their citizenship status and whether and how they may need to apply for a passport? Fourthly, for those who have already applied for their passport and others who may wish to do so, will the Minister confirm whether there will be any expedited procedures to process such applications without any further delays? Finally, will he clarify the Government’s position on any fees that may be payable and whether there are any plans to waive fees for the applicants in question? I feel that in the coming months Members from both sides of the House may well come across some of those issues in their constituencies, and I am sure everyone would find it helpful to have that information on those points. As I say, the Opposition support this Bill and are happy to facilitate its rapid passage through Parliament.

Rosie Winterton: I call the Scottish National party spokesperson.

Alison Thewliss: I, too, do not seek to detain the House for long on this Bill. It is a rare day indeed when I agree with something that the  Immigration Minister is bringing forward—let us get that point down and hope we never return to it again. [Laughter.]
The SNP welcomes the Bill for the clarity it will bring, particularly given the confusion that has been caused by different approaches taken by the Home Office on the question of what “settled” means in the context of free movement. I am reassured by the briefing that we received from the Project for the Registration of Children as British Citizens, the3million, the Immigration Law Practitioners Association and Amnesty International, which also welcomes the Bill. The way in which the Home Office has consulted with them on it is welcome and something the Home Office ought to be doing more often. The briefing states:
“We are grateful to the Home Office for consulting with us immediately prior to this Bill’s introduction. Nonetheless, the history of this matter provides a further example of our concerns that British citizenship, and British nationality law from which the right to citizenship is derived, has been badly mistreated by successive Governments over a period of some decades. This is but one stark example.”
So before the Government get too much into slapping themselves on the back for this Bill, they should be cognisant of the fact that many issues associated with citizenship remain, many of which we will see in our surgeries, as local MPs.
I do not seek to reiterate what others have said, but I am concerned at the lack of official statistics identified in the equality impact assessment. It mentions 167,000 children born to EEA mothers between 1983 and 2000, but there are an unknown number of grandchildren also in this cohort. So what further work are the Government doing both to identify these people to let them know what their rights are and what they should do, and to make sure that Home Office and Passport Office officials who are making the decisions are also very clear about the situation. The lack of clarity over this has been a real problem. It should be the case that everybody, when applying for their first passport, knows that they are doing so properly and have the right to do so to avoid any confusion. There is nothing worse than people applying for passports and then there being an unexpected delay in the process. We are coming into that season where we will get those kinds of inquiries.
I understand from the Library briefing that the Home Office had stopped issuing first-time British passports to people affected by this, so it would be useful to hear from the Minister exactly how many people are in this paused group and what will be happening now to ensure that they get their passports. I expect that there has been some delay involved as a result of that passport being paused—people will not have been able to travel or do the things that they wanted to do and they will want to know when they will get those passports once the process restarts. It would be useful to have a picture of exactly how many people are affected, and I am sure that the Passport Office will have those figures.
I also note that the equality impact assessment references “The Windrush Lessons Learned Review” of Wendy Williams. This uncertainty around status speaks to some of the difficulties caused for the Windrush generation, but as the UK Government have ditched some of their commitments on upholding the principles from the review, can we be assured that the confusion that has led up to this point will not be recreated in a new EEA  Windrush? People who have the right to be here, who have settled status, and who have the right to apply for a British passport should face no further impediment or confusion in applying for their passport.
In closing, there is a lot more that the Government need to do to improve the processes around citizenship and applying for passports and to make sure that there is a clearer, simpler, cheaper and more effective route to citizenship in the UK. I am certain that an independent Scotland will seek to make that route much clearer, much simpler and better so that people have the right to be here and can fully participate as Scottish citizens in an independent Scotland, and I look forward to that day.

Robert Jenrick: I am grateful to the hon. Members for Aberavon (Stephen Kinnock) and for Glasgow Central (Alison Thewliss) for their support for the Bill. Hopefully, this spirit of unity will be contagious for other legislation shortly to return to the House.
Let me reply to the specific and valid questions. First, on statistics, I will not repeat the numbers that the hon. Gentleman raised. Those are the best assessment that the Home Office currently has. We do not have a plan to ask the ONS, or any other body, to do further, deeper research. We do not feel that that is necessary, primarily because, by virtue of this piece of legislation, the rights of those British citizens will be confirmed. It will be retrospective, so those individuals should not need to do anything now, other than the small category of individuals whose passport applications were paused. We will need people at the Home Office and the Passport Office to process those applications as soon as possible.
The hon. Lady asked how many applications had been paused. As of 26 May, 95 passport applications were on hold. We are in communication with those affected to keep them updated. Once the legislation passes, it will be beyond doubt that they are British citizens in law and have always been so and we will be able to proceed with their passport applications. I will ask the Passport Office to process their applications expeditiously, so that any inconvenience they may have been put through can be resolved as quickly as possible. There will not be a need for them to pay any additional fee beyond what they have already paid, which will be the normal fee for a British citizen renewing their passport or applying for a first-time passport.

Alison Thewliss: When I have experienced casework delays with the Department for Work and Pensions, a consolatory payment is sometimes offered to people where there have been extensive delays. Given that only 95 people are involved, would that be appropriate in this case?

Robert Jenrick: We have not considered that, and I do not think it is necessary. We are of course sorry that those individuals have been inconvenienced; that was never the Home Office’s intention, either today or in the past. This litigation was unexpected and we have set out to remedy it as quickly as possible. I hope the hon. Lady will appreciate that we have brought forward this legislation quickly and, as she rightly noted, we have tried to consult relevant stakeholders so that there are good communications prior to its introduction.
The hon. Lady also mentioned Windrush; that is a very serious situation, but is a quite a different situation from the one we find ourselves in here. In this legislation we are reflecting a position that has existed in policy and guidance for several decades. We have responded quickly to implement the legal change necessary, following the court case heard in October last year, to provide that certainty. As I said in my opening remarks, we are not creating any new British citizens here, but recognising the citizenship of that cohort in law whom we had always believed existed and reflected in policy.
We remain absolutely committed, of course, to righting the wrongs of Windrush, whether through the Windrush compensation fund or more broadly, as she referred to, through ensuring that the Home Office makes good on its commitments to the Wendy Williams review. That is something we take very seriously.
In terms of any other impacts upon the individuals concerned here, there should be none. Once we have processed the remaining passport applications, those British citizens can and should continue with their lives as previously. We will ensure that Home Office staff, Passport Office personnel and any relevant stakeholders are properly trained so that, should people come forward with concerns in the weeks, months or years ahead as a result of this case, we can reassure them that, once this has been settled in law, they are and have always been British citizens.
I hope that responds to all the points made. With that, I shall conclude my remarks.
Question put and agreed to.
Bill accordingly read a Second time.

British Nationality  (Regularisation of Past Practice) Bill

Considered in Committee (Order, this day)
[Dame Rosie Winterton in the Chair]

Rosie Winterton: I remind hon. Members that in Committee they should not address the Chair as Deputy Speaker. Please use our names. Madam Chair, Chair, Madam Chairman or Mr Chairman are also acceptable.

Clause 1 - Immigration restrictions to be disregarded  in certain cases

Question proposed, That the clause stand part of the Bill.

Rosie Winterton: With this it will be convenient to consider clause 2 stand part.

Robert Jenrick: Given the short nature of the Bill, I will not delay the Committee unduly, but I want to explain briefly the nature of the clauses.
Clause 1 amends the British Nationality Act 1981 to confirm that an individual exercising a free movement right in the UK in the relevant period was not subject to restrictions on the period for which they could remain. The aim of this clause is to provide legal certainty on the citizenship status of individuals born in the relevant period to a parent who was considered settled on the basis of living in the United Kingdom and exercising a free movement right here, or those who registered or naturalised based on that policy.
The clause does not create new British citizens where there would previously have been no reasonable expectation, on the basis of published policy and operational practice, of being British. It does not change anything for people who have always been considered British; rather, it simply confirms in law the position they have always been in. The clause does not necessitate that they make a separate application to become British and is not related to the UK’s departure from the European Union. This issue has arisen separately and has been highlighted by the recent domestic legislation.
For England, Scotland, Wales and Northern Ireland, the remedial period is 1 January 1983 to 1 October 2000. That is the period between the British Nationality Act 1981 coming into force and the introduction by regulations of the requirement for European economic area nationals to have indefinite leave to be regarded as free from immigration time restrictions. During the remedial period, an EEA national was treated as settled in the UK if they were living here and exercising a free movement right. Clause 1 confirms that position.
The remedial periods specified in clause 1 are different in the Bailiwick of Jersey, the Bailiwick of Guernsey and the Isle of Man. Those jurisdictions fall within the territorial extent of the BNA and people born there are automatically British citizens. However, the Crown dependencies have their own legal systems and there are variations in the times at which they treated EU citizens  as free of immigration restrictions. Clause 1 reflects those differences to ensure that someone who had a reasonable expectation of being British under previous published policy or operational practice keeps the citizenship to which they thought they were entitled.
Clause 1(2) also specifies that the measures introduced by subsection (1) are to be treated as always having had effect. I understand that that approach is somewhat unusual, as it is usually right and proper that the consequences of past events can be understood in the context of the law as it stood at the time, not what it may become in the future, but the case for retrospection in this situation is clear.
Were the measures set out in clause 1 prospective only, it would mean that affected individuals would become British citizens only after the date when the measure came into force. That could have wide-ranging consequences for their ability to live, work and study in the UK, and may inadvertently leave individuals liable to repay benefits or healthcare costs to which they would not technically have been entitled at the time if they were not then, in law, a British citizen. It would also have knock-on effects for the children or family members of those affected individuals who became British citizens by virtue of their status.
It is clear, therefore, that in order to restore such individuals to the position that they and the Home Office have always considered them to be in, and to ensure that they suffer no adverse consequence through no fault of their own, the measures set out in clause 1 must be retrospective.
In conclusion, long-standing Government policy will now, by virtue of the Bill, be confirmed in law, thereby protecting the nationality status of people born in the UK to parents who were considered settled on the basis of exercising a free movement right, and those who registered or naturalised as British citizens based on that policy. That is clearly the right thing to do for the countless UK-born people who have long considered themselves to be British. For those reasons, I commend the clauses to the Committee.
Question put and agreed to.
Clause 1 accordingly ordered to stand part of the Bill.
Clause 2 ordered to stand part of the Bill.
The Deputy Speaker resumed the Chair.
Bill reported, without amendment.
Bill, not amended, considered.
Third Reading

Robert Jenrick: I beg to move, That the Bill be now read the Third time.
If only all Home Office Bills were as smooth as this one. It is a pleasure to speak on Third Reading and to use this opportunity to thank my officials at the Home Office for the good work they have done in producing this Bill in quick time, which provides the legal certainty that a significant number of people in this country—our fellow citizens—deserve. It is absolutely right that we put their citizenship status beyond doubt as quickly as possible, so that they are in no way disadvantaged and can continue their lives with the same rights and entitlements they have always enjoyed.
I thank all those who have prioritised the passage of the Bill through the House, including the House authorities and the Bill team. I particularly thank representatives from the Project for the Registration of Children as British Citizens, the Immigration Law Practitioners’ Association and the3million, which have worked collaboratively and fruitfully with Government officials as the Bill has been developed.
I also thank the hon. Member for Aberavon (Stephen Kinnock) and the hon. Member for Glasgow Central (Alison Thewliss) for their support, which is appreciated, and Members on both sides of the House who came today to represent cases that had arisen in their constituencies. They can now report to their constituents, as we all can, that this important matter is being resolved. For the reasons I have set out, I urge all Members to support the Bill in its passage to the other place.

Rosie Winterton: I call the shadow Minister.

Stephen Kinnock: I echo everything that the Minister has just said and add our thanks to his officials and all the key organisations that have played a role in shaping the Bill. I also want to say to the Minister that this is very much a one-off—this sort of outbreak of violent agreement is a bug, not a feature. As I have said, we on the Labour Benches are very happy to support the rapid facilitation of the Bill through Parliament.

Rosie Winterton: I call the SNP spokesperson.

Alison Thewliss: I thank the Minister. This will perhaps be a lesson to him to bring forward Bills that he has consulted on and that are less contentious than those he usually brings to the House. I would also like to make him an offer: now that he has the whole afternoon free, I have 145 outstanding immigration cases that I would be happy to discuss with him.
Question put and agreed to.
Bill accordingly read the Third time and passed.

Business without Debate

Delegated Legislation (committees)

Ordered,
That the Measure passed by the General Synod of the Church of England, entitled Diocesan Stipends Funds (Amendment) Measure (HC 1413), a copy of which was laid before this House on 24 May, be referred to a Delegated Legislation Committee.— (Steve Double.)

Business of the House

Ordered,
That notices of Amendments, new Clauses and new Schedules to be moved in Committee in respect of the Electronic Trade Documents Bill [Lords] may be accepted by the Clerks at the Table before it has been read a second time.—(Steve Double.)

Public Accounts

Ordered,
That James Cartlidge be discharged from the Committee of Public Accounts and Gareth Davies be added.—(Mr Marcus Jones, on behalf of the Committee of Selection.)

Errol Graham: DWP and Safeguarding Adults Board Inquiry

Motion made, and Question proposed, That this House do now adjourn.—(Steve Double.)

Debbie Abrahams: I start by thanking Mr Speaker and his office for granting me this very important Adjournment debate in relation to Errol Graham, and in particular the safeguarding review by Nottingham City safeguarding adults board that was published a couple of weeks ago.
It was June 2018 when bailiffs came to Errol Graham’s flat to evict him and discovered that he was dead. Errol was penniless—he had no gas, no electricity and no water. His only food was two out-of-date cans of fish. At his 2019 inquest, the coroner confirmed that Errol had weighed four and a half stone when he died, and that the cause of death was starvation. He was 57 years old.
Errol suffered from severe mental ill health. He had been in receipt of employment and support allowance and housing benefit since 2014, until he missed a fitness for work assessment in 2017. He did not respond to the Department for Work and Pensions when it tried to contact him by phone and in person, and eight months later his ESA and housing benefit payments were halted, in accordance with DWP policy.
The coroner’s report fell short of issuing a section 28 prevention of future deaths notice to the DWP over Errol’s death, as the DWP witness at the time stated that a safeguarding policy review was underway by the Department. However, in July 2020 the coroner had to write to the DWP again, as it had failed to supply her with the new safeguarding policy. It is a bit moot whether there has actually been a revised safeguarding policy. Certainly, information from the House of Commons Library suggests that there have just been tweaks around the edges. There has been no new safeguarding policy, and as we will see as I proceed, the impacts have been felt elsewhere.
Just before recess, Nottingham City safeguarding adults board published an independent review of what it described as the “shocking and disturbing” events that led to Mr Graham’s tragic and lonely death. In that report, the board concluded that multiple failings by the DWP, Mr Graham’s GP practice and his social landlord meant that chances to save him were missed. Moreover, the Department for Work and Pensions also failed to share the severity of Mr Graham’s illness with other agencies, including his landlord at Nottingham City Homes. Knowing Mr Graham’s illness, the DWP failed to contact his GP for potential reasons as to why he was not engaging with the Department. Significantly, it has now emerged that the Department failed to disclose information from Errol’s 2014 work capability assessment to that independent safeguarding review. A communiqué from Nottingham City Council on 17 May stated that the independent chair of Nottingham City safeguarding adults board, Lesley Hutchinson, had said:
“We can confirm that the 2014 documents were not provided”
by the DWP
“for consideration by the review author.”

Jim Shannon: I commend the hon. Lady for bringing forward this debate. She has compassion and a heart for people who are in trouble, and we commend her for that. She often brings forward things that we all add our support to. Each day in our offices we witness people who have fallen foul of the DWP: those with extreme health difficulties, people who are desperate, people at their lowest—that is just the way they have had it. Does she feel that the DWP needs to be aware of those who need help, and that DWP staff need to be trained accordingly so that they can spot those who are in trouble? It is sometimes a knack, but I believe that is important.

Debbie Abrahams: The hon. Gentleman is absolutely right. In fact, he was in the Chamber back in February 2020 when we had the previous debate and described some of these events. Three years on, nothing has changed. He is absolutely right: not only would it be nice, but it is a requirement. The DWP has a safeguarding requirement and a responsibility to ensure that the claimants who come to its attention are adequately protected.

Lilian Greenwood: I congratulate my hon. Friend on securing today’s debate, which obviously highlights the sad death of my constituent Errol Graham. The purpose of a safeguarding adults review is not to hold an individual or organisation to account, but it is about agencies learning lessons to improve future practice. If tragedies such as Errol’s death are to be prevented in future, which I am sure is what we all want, surely all agencies must share the relevant information with the board. Does she share my concern—I know she does—that in failing to share that 2014 assessment, the DWP did not assist the local authority in its really important duty in that respect?

Debbie Abrahams: My hon. Friend is absolutely right. That is the purpose of this Adjournment debate. The situation has gone on for too long, with information not shared and information lost—I will come to that later on. There have been concerns about how the Department has acted to safeguard not just individual claimants but the information it has on claimants, so that it can learn those lessons and improve its practices.
This information from the 2014 work capability assessment—do not forget, Errol died in 2018—expressed in the clearest language that he would not be fit to work “indefinitely”. That was the language of the assessor. It was not him saying that he was not fit to work; it was the language on that 2014 work capability assessment, which was not presented either to the safeguarding review or to the High Court judge. It also was not presented at the coroner’s inquest. The presenting of that report to the organisations that should have had it when making assessments of the circumstances of Errol’s death has been carefully avoided. This is serious stuff. I know that the Minister is relatively new in the role, but I want to know why that 2014 work capability assessment was not provided specifically to the recent safeguarding review board. I will go back to the other instances in a moment.
My hon. Friend is absolutely right about to Errol. Errol was her constituent, and I have had long-standing contact with Mr Graham’s daughter-in-law, Alison Burton.  She has said that the Department’s behaviour raises “serious questions” about its honesty and transparency, given the Department’s knowledge of Errol’s significant mental distress and its failure to disclose it to the safeguarding review. That can be taken in conjunction with the Department’s failure to provide peer review reports into the deaths of claimants to the independent reviewers of the work capability assessment, Professor Harrington and Dr Litchfield. Members will be aware that there was a statutory requirement to undertake independent reviews of the work capability assessment. There were two separate assessors; one was Professor Harrington, and the other was Professor Litchfield. None of the peer reviews—there have been a number of different names for what happens when the Department investigates the deaths of claimants—or serious case reviews and so on were provided to the independent reviewers.
The response I got when I asked various urgent questions on this issue a few years ago was, “Well, they did not ask for them.” Then—this is all on the record; I was going over it last night when I was writing this speech— in response to the urgent question that I secured on this issue, the answer was, “Well, they were lost. We no longer have these reports, so we cannot provide them.” It is clear to see why there is a crisis in confidence in the Department and why there is a lack of trust from not just families, but claimants themselves.
This issue needs to be seen in the context of the recent action by the Equality and Human Rights Commission, which 14 months ago issued a section 23 notice to the Department over its concerns about the evidence that the Department is discriminating against disabled claimants. For 14 months, there has been nothing—nothing—from the Department, and there has been nothing from this Government. Surely as a Government they would see that the equality laws that have been set for everyone should also apply to them, but, no, 14 months on, there has been nothing. I will let people draw their own conclusion on what drives that, but if we say that the first duty of any Government is to keep their citizens safe, I think we would all agree that the DWP is clearly failing as far as disabled claimants are concerned.
In a 21st-century civilised society, the circumstances that led to Errol’s death should shock us all, but Errol’s death, unfortunately, is just one of many, and there is a pattern here. In addition to the lack of safeguarding provisions that led to Errol’s death—even though, as I say, there was an awareness from 2014 of his severe condition—many social security claimants have been found fit to work and have then died. For example, a freedom of information application in 2019 showed that 274 claimants a month—a month—who had been found fit for work subsequently died within six months, which is a much higher mortality rate than for the population as a whole.
The true scale and causes of these deaths are simply unknown. In an answer to a written question I submitted last year, it was revealed that between 2019—so since the inquest into Errol’s death—and June 2022, 140 more claimants and 39 serious harms were being investigated by the DWP, but that is only what the Department says it is investigating. The National Audit Office, in its review in 2020, said that it is probably a much, much higher figure.
Errol’s story is an example of the Department’s failure to safeguard claimants, and subsequently to avoid any form of scrutiny or accountability. Any Government who were confident in their policies would be open to scrutiny, but there is a pattern of avoidance by the Department, including the refusal to provide various reports and data to the Work and Pensions Committee, on which I sit. I have asked this in the past, but I am going to give the Minister and the Government one more opportunity: will the Government convene an independent inquiry into the scale and causes of the deaths of social security claimants? The Minister is welcome to intervene on me, but if he wants to include that in his response to the debate, that would be absolutely fine.
The seven Nolan principles of public life apply to us all—Ministers and MPs. Two of them are openness and transparency, but unfortunately, those principles are absent from the Minister’s Department. In an area such as social security, this could not be more important. We need a paradigm shift in our social security system from one that demonises to one that is supportive and enabling. Disappointingly, I see a re-emergence of the vile shirker-scrounger narrative from 10 years ago, and a focus on working-age sick and disabled people and social security claimants.
I do not know whether there is anybody from The Daily Telegraph in the Gallery, but I have to point out that I saw its shameful editorial last week. Not only was it ignorant in some of the assertions made, but it has what I see as absolutely disgraceful rhetoric in trying to vilify social security claimants. Just like our NHS, our social security system should be there for any one of us in our time of need, providing dignity and security for all.
In 2020, I read from a list of people who we knew had died. At the time, I said:
“The death of any person as a result of Government policy is nothing less than a scandal… For too long, the Department has failed to address the effects of its policies. It must now act. Enough is enough.”—[Official Report, 24 February 2020; Vol. 672, c. 155.]
Three years later, 140 more families are grieving. When will the Government sort this out?

Lilian Greenwood: I thank my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams) for all her work on this issue, and for the support that she has offered to Errol Graham’s family. Errol’s death was shocking and disturbing. We cannot change what happened, but we can and must learn the lessons. I am sure that all Members of the House have experience of supporting constituents who are facing work capability assessments, and know the anxiety that such reviews can induce.
I was not intending to speak today, but reading the safeguarding adults board review again prompted me to want to share this. At his inquest, a letter written by Errol was read out. His family believe that he had intended to take it along to the work capability assessment. We do not know that; the letter is undated and it was never sent, but I think it gives an insight into how he felt, and I hope the House will indulge me if I share it now—it is relatively short.
“Dear Sir/Madam,
I’ve had to put in writing how I feel as I find it hard to express myself. I wish I could feel and function normally like anyone else, but I find this very hard. I can’t say I have a typical day because some are good, not many, clouded by very bad days. I get up as late as I can so that the day doesn’t seem too long. On a good day I open my curtains, but mostly they stay shut. I find it hard to leave the house on bad days. I don’t want to see anyone or talk to anyone. It’s not nice living this way. I’m afraid to put my heating on and sit with a quilt around me to keep me warm. I dread any mail coming, frightened of what it might be because I don’t have the means to pay, and this is very distressing. Most days I go to bed hungry, and I feel I’m not even surviving how I should be. Little things that people brush off are big things to me.
I have come on my own today because I have been unable to share how I feel with anyone because I don’t think they would understand. It has made me ill to come here today. It is a big ordeal for me. My nerves are terrible and coping with this lifestyle wears me out. Sometimes I can’t stand to even hear the washing machine and I wish I knew why. Being locked away in my flat I feel I don’t have to face anyone. At the same time, it drives me insane. I think I feel more secure on my own with my own company, but wish it wasn’t like that. I’m not a drinker and have never been so don’t think that I’m here to abuse the system. Please judge me fairly. I am a good person but overshadowed by depression. All I want in life is to live normally. That would be the answer to my prayers. Thank you to all for taking the time to read this letter, I really appreciate it. I don’t know how I’ll cope when I see you all. I hope I will be OK.”
I appreciate that the DWP did not know that that was how Errol felt, and neither did his social landlord or his GP. The coroner concluded that none of them were individually responsible for his death. However, the DWP was aware that Errol had a mental ill health condition.
In his response, will the Minister set out the steps that he is taking now to ensure that other claimants, both those currently supported by the DWP and those who might need support in the future, get the support that they need, and do not have their benefits cut off as a result of their poor mental health and inability to engage with the outside world and the agencies that should be there to support them? Errol’s case is utterly heartbreaking. We cannot change what happened, but we must learn the lessons for others and prevent future deaths of that sort.

Tom Pursglove: I congratulate the hon. Member for Oldham East and Saddleworth (Debbie Abrahams) on securing this important debate. It is, of course, always tragic when a person dies having been in receipt of benefits, and my sincere condolences remain with Mr Graham’s family. I assure you, Madam Deputy Speaker, that where there is an allegation that the DWP’s actions may have in any way contributed to this outcome, we take it very seriously.
To begin with, I want to set in context the nature of the recommendations made by Nottingham City safeguarding adults board. Five recommendations were made, with three specific to Nottingham City Homes, one applying to all agencies—with an emphasis placed on Nottingham City Homes—and one specifically aimed at the DWP, working jointly with Nottingham City safeguarding adults board. I confirm to the House that the Department for Work and Pensions has accepted that recommendation, and my officials will work constructively and collaboratively with the safeguarding  board on that. We will approach taking that recommendation forward in good faith and with proper dialogue.
I also want to give some background on the case in question. Mr Graham was a claimant in receipt of employment and support allowance until his claim was closed in October 2017 following non-attendance at a work capability assessment. In the interim, he had not responded to calls, text messages or two home visits by the Department. Mr Graham had ceased to engage with his family, healthcare and other statutory agencies over a number of years, and was found deceased in his flat in or around June 2018. An inquest into Mr Graham’s death was held in June 2019.
Since July 2020, my Department has co-operated fully and openly with Nottingham City safeguarding adults board on this very sad case. I am pleased to see that its report notes the “significant changes” that the DWP has made in its support of vulnerable claimants since 2019.
The board wrote to the Department in July 2021 confirming that it would be carrying out a safeguarding adults review into the death of Errol Graham. For the avoidance of doubt, it might be helpful to quote exactly how the board explained the scope of the review from its own terms of reference. It said:
“The scope period for the review is from June 2017—the date EG’s benefit review process began—until 20.06.2018, the date EG unfortunately died. However, if agencies have information of relevance to the ToR before that date…it would be helpful if they briefly summarised that as well”.
The Department complied with the board’s request, providing it with detailed information in scope of the review as well as briefly summarising information from before 2017, as we were asked to do.

Debbie Abrahams: The Minister may be coming on to this—I hope he is. Will he ensure that he responds to my point about why the details of the 2014 work capability assessment were not made available to the review?

Tom Pursglove: If I may, I will make a little progress on this point. I am aware that a journalist has claimed that officials hid information from the board, but that is simply not true. They had no reason to do so. As explained, the board had the information that it requested. The board’s published report includes a wording change stating that agencies were asked to “provide additional information” and not “briefly summarise” as in previous versions. That slight wording change could have led to the wrong impression that the DWP was asked to provide every single form and document relating to Mr Graham’s benefit claim—even those outside the scope of the review. I believe that may have contributed to claims that information was hidden.
It is important to note that we know that the board extensively reviewed the findings of the 2021 judicial review proceedings in which a former Secretary of State for Work and Pensions successfully defended a claim in the High Court, challenging some of the decisions made in this case. That judgment referred to the content of a previous work capability assessment of Mr Graham’s. The safeguarding board clearly understood from that, and the other information provided, what officials had discovered about Mr Graham’s state of mind. It is difficult to see what the DWP would have gained by hiding it when the board had stated its review of the  findings. Officials continue to engage with the Nottingham City safeguarding adults board and we welcome having further conversations with it if needed.
It is important to understand the role of safeguarding adult boards in the context of Mr Graham’s case. National guidance on safeguarding adults boards states:
“The purpose of a SAR is not to hold any individual or organisation to account, because there are other processes and regulatory bodies available for that purpose; they are about learning lessons for the future”.
Those other processes include the coronial process, where coroners investigate unnatural deaths and where the cause of death is unknown. Nottingham City safeguarding adults board’s role was to look at how agencies worked together to support Mr Graham and what lessons it could learn from his tragic death, not to re-examine the court’s previous judgment or the coroner’s conclusions. My Department’s key obligation is to ensure that claimants receive the correct benefit entitlement at the right time. While we do not have a statutory duty of care or safeguarding duty, that does not mean that we do not care. We often need to consider a customer’s particular circumstances to provide the right service or ensure appropriate support. We can help direct our claimants to the most appropriate body to meet their needs.

Debbie Abrahams: Why, then, did the witness speaking on behalf of the Department at the 2019 inquest make the point that a new safeguarding policy was being developed by the Department, if the Government do not have a safeguarding policy requirement?

Tom Pursglove: What I will do is set out the actions the Department is taking to ensure that our safeguarding obligations are upheld and that we support claimants in an appropriate way that is responsive to their needs and circumstances. The concrete actions the Department has taken to improve matters relating to this issue in recent years reflect previous learning.
I would also like to deal specifically with the point the hon. Lady made about holding a public inquiry. I am not in a position today to be able to commit to that. Clearly, attempted suicides and suicides are very complex issues. Where there is an allegation that the Department’s actions may have contributed to that outcome, we take it very seriously. There already exists a wide, independent and transparent system for investigating such issues. Causes of death are determined by a doctor or coroner. Where a coroner identifies a risk of other deaths occurring in similar circumstances, they will issue a prevention of future deaths report to highlight that. The independent case examiner investigates serious complaints relating to the DWP. They report to the complainant and publish case studies of findings in the ICE annual report. The parliamentary and health service ombudsman also looks at serious cases and publishes reports on its website. For those reasons it is not our intention to set up an independent inquiry, but there are steps we have taken as a Department to improve matters in relation to safeguarding and I just want to set those out for the House, because they have already been implemented to support vulnerable customers. The initiatives were also highlighted, as I say, in Nottingham City safeguarding adults board report as changes the Department has implemented to improve services, and that point was acknowledged.
First, we have introduced more than 30 advanced customer support senior leaders to support colleagues when dealing with customers who may be vulnerable or at-risk. Central to the role of those senior leaders is the work they take forward with external partners and organisations, creating relationships to support citizens and providing the critical link into external agencies’ escalation routes and enabling cross-agency case collaboration. The Department also conducts internal process reviews, which form a core part of the Department’s overall approach to learning and help inform improvement activities across all DWP product lines. Internal process reviews can make recommendations to help the Department to improve its processes, policies or quality of service. We commission them in response to a range of claimant circumstances or events, which include, but are not limited to, suicides, suicide attempts and self-harm. Not all internal process reviews conducted after a death relate to suicide. Therefore, those classified as relating to a death should not automatically be read as suicide cases. Furthermore, the fact that an internal process review is being carried out does not mean that the DWP has been found culpable in the circumstances or events leading to a claimant’s death or a serious incident.
Similarly, the serious harm that prompts an internal process review investigation may relate to self-harm or a suicide attempt, or may also refer to other events that are considered to merit investigation. We have also broadened the range of circumstances where an internal process review is carried out, to increase our learning from cases where outcomes have been poor for claimants.
The Department has also set up the serious case panel, which meets quarterly to consider themes and issues that have arisen across DWP service lines, in order to agree changes and improvements. The panel has commissioned and implemented several changes since it was introduced. They include changes made to visiting vulnerable customers, where they have ceased to engage with the Department. Following two unsuccessful visits where concerns about the customer remain, the claim will no longer automatically be closed. Instead, the case will be escalated to an advanced customer support senior leader, who will liaise with relevant external agencies to assure the customer’s safety.
The Department has also made changes to guidance on administering large payments to customers who may face challenges receiving or handling such payments. The panel has also prioritised the delivery of mental health awareness training to customer-facing colleagues. The training will build colleague capability and confidence in supporting customers with mental health conditions. Going forward, I am keen to engage with stakeholders, including from mental health charities and other organisations, to continue to make improvements to our services for our customers. I recently met Rethink, a mental health charity that was representing the families of some benefit claimants who have passed away. It is my intention to organise a future meeting with a representative member of the families, in partnership with Rethink.
I want to address a specific point that the hon. Lady has raised a number of times in this House about the Equality and Human Rights Commission in relation to the ongoing section 23 agreement discussions. We continue  to engage with that in good faith, but we must act in accordance with our legal obligations. The negotiations provided for under the Equality Act 2006 have been expressly confidential. Therefore, I cannot give a running update on the contents of the discussions. There are legal provisions under section 6 of the Equality Act that prevent disclosure of further details. Discussions are subject to general law principles. Parts of the discussions are also subject to legal privilege.

Debbie Abrahams: I have two brief points. First, if we have had all the updates on safeguarding, why have 140 more people died in the intervening period? The Minister seems to be saying, “Everything is fine, we’ve done this,” but still, the Department is investigating 140 people, and we do not know the true figure. Secondly, there is nothing in the 2006 Act that says that the Department has to take 14 months to reach an agreement on how to improve the services and not discriminate against disabled people. There is nothing—I have gone through it.

Tom Pursglove: I do not accept the hon. Lady’s initial point. I take these matters incredibly seriously. I am engaging thoroughly with stakeholders around these issues. She will recognise my approach to meeting Rethink and bereaved family members to discuss these issues and to work out what more we can do to improve these processes and in an open, transparent and constructive way. That is how I approach my responsibilities, and that will continue to be the case. These structures have been put in place, as the safeguarding board recognises, which are considerable improvements in recent times. Of course, we must always keep under review the appropriateness of these structures. We must make sure that learning from specific cases is captured. Processes and the way in which we go about our activities as a Department must be responsive to the issues raised through those formal structures.
On the section 23 discussions that are ongoing, the hon. Lady will recognise that this is a matter not just for the DWP. The discussions are going on between two parties, and both sides need to act in good faith in reaching conclusions. It is right that we do that in response to the commission from the EHRC, and in a way that is compatible with the requirements under the Equality Act. That is what we will continue to do. As I have said before, when I have a substantive update that I am able to provide to the House, I will do that. I have made that undertaking, which I reiterate today. It would be inappropriate for the Department to discuss the contents of what may or may not be included within an agreement, or the contents of any information that may be published in future, while confidential discussions are ongoing.
My Department strives to be a learning organisation, continually seeking to better understand the experiences of our customers and any challenges that they may face in their interactions with us. We are committed to using that learning to develop our systems and processes and to make improvements to the experience of our customers. In fact, that underpins all the work we are doing through our White Paper reforms, to ensure that people have a better experience of the journey within the benefits system and that we provide benefits that are more flexible.

Lilian Greenwood: I have listened with interest to what the Minister has said. As a result of the changes that the Department has made, is he confident that no one else will face the same position Errol faced because he disengaged? Nobody denies that he was not engaging with his GP, housing provider or the DWP, but the tragic fact is that he starved to death as a result of that failure to engage. The Minister described the new layer that is now in place if there are two failed safeguarding visits, but is he confident that someone whose mental ill health prevents them from engaging, as is set out so clearly and poignantly in the letter, would not face the same position of having their benefits withdrawn and, as a result, having nothing to eat, in a freezing cold home, with no utilities connected?

Tom Pursglove: It is impossible not to be incredibly moved and concerned by what happened to Errol Graham. Both Ministers and officials in the Department are absolutely determined that the learning that comes out of this case, which is reflected in the recommendation that has been made by the safeguarding adults board, must be acted upon. We must continue to consistently ensure that where issues that require improvement are highlighted, we take steps in reality, in terms of our processes, to make sure that that follows on.
It is significant that there are now checks that ensure people’s cases are not suspended or terminated when we have not heard back from them, and that we have senior customer service leaders who work on a cross-agency basis to ensure that people are properly supported. They were the right steps to take and they have been informed by cases like this. It is right that we continue to constantly monitor and understand our claimants’ circumstances and needs, and that we improve the journey through the benefits system more generally, wherever there is an opportunity to do that.
That is why I am passionate about the reforms that were announced through the White Paper, including matching expert assessors with particular conditions, monitoring fluctuating conditions more effectively and  ensuring that people have the smoothest possible journey in their experience and interaction with the DWP. The hon. Lady has my commitment that we will continue to learn. We will undertake to make sure that all our processes are fit for purpose and kept under review, and to make changes when they are required.
That is the constructive spirit in which I am approaching our conversations with Rethink, for example, which has an insight into mental health conditions, so that we can understand what more we can do to ensure our processes are responsive to those with mental health conditions. I know Rethink participated in some engagement with my officials only yesterday.

Debbie Abrahams: My final point is that Rethink is calling for an independent public inquiry into the death. Will the Minister be supporting that campaign by Rethink?

Tom Pursglove: The position relating to a public inquiry is the position that I set out earlier, but within our existing processes and the transparency applying to them, I am keen to hear from Rethink and other charities what more they think we can do, or which parts of those processes they think could be improved. I approach those conversations very much in that spirit.
Ultimately, our measures will ensure that we provide benefits for, in particular, our most vulnerable customers in a more flexible and compassionate manner, and that their interactions with us constitute a positive experience. We will continue to drive forward change within the Department on the basis of what we have learnt. I appreciate the opportunity I have had this afternoon to describe some of the work that the Department is doing, “on the ground floor”, to ensure that our systems are as responsive as possible, and that all learning is captured and acted upon.
Question put and agreed to.
House adjourned.